Light Bridge Counseling Group LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIGHT BRIDGE COUNSELING GROUP LLC

Practice address

3238 NW 47TH Ave
Coconut Creek, FL 33063-1800

Phone

(954) 205-6773

NPI assigned

Dec 9, 2025

Last updated

Dec 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gavin Vanderwal Malcolm, LCSWNPI 1811669062

Title

Owner

Phone

(954) 205-6773

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gavin Malcolm, LCSW

  • Clinical Social Worker
  • Coconut Creek, FL
  • NPI 1811669062
  NPD Authorized official

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

{
    "created_epoch": "1765238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765238400000",
    "number": "1770446312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3238 NW 47TH AVE",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330631800",
            "telephone_number": "954-205-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3238 NW 47TH AVE",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330631800",
            "telephone_number": "954-205-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT BRIDGE COUNSELING GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-09",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "VANDERWAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-205-6773",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Coconut Creek, FL
• Providers in Coconut Creek, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.