Provider Demographics
NPI:1164153623
Name:MCBAY, BROOKE ALEXANDRIA
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRIA
Last Name:MCBAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0065
Mailing Address - Country:US
Mailing Address - Phone:951-956-3948
Mailing Address - Fax:
Practice Address - Street 1:1910 ORANGE TREE LN STE 300
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4500
Practice Address - Country:US
Practice Address - Phone:909-474-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist