Newlife Bridge Counseling PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

62816 Issued in TX

Legal business name

NEWLIFE BRIDGE COUNSELING PLLC

Practice address

200 Flower Mound Rd
Flower Mound, TX 75028-3421

Phone

(972) 835-4610

NPI assigned

Sep 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jason Jungsub Kim, PH.D, LPC-SNPI 1114259892

Title

Director

Phone

(972) 835-4610

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Kim, LPC

  • Professional Counselor
  • Flower Mound, TX
  • NPI 1114259892
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1043688369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3304 EL DORADO DR",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762101218",
            "telephone_number": "972-835-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FLOWER MOUND RD",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750283421",
            "telephone_number": "972-835-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWLIFE BRIDGE COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JUNGSUB",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "972-835-4610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "62816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.