Organization Name: | NEWLIFE BRIDGE COUNSELING PLLC |
NPI Number: | 1043688369 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUNG-SUB KIM (DIRECTOR) |
Mailing Address: | 200 Flower Mound Rd Flower Mound |
State: | TX US |
Postal Code: | 750283421 |
Phone Number: | 9728354610 |
Fax Number: | |
NPI Enumeration Date: | 09/03/2015 |
NPI Last Update Date: | 09/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 62816 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |