MEDICARE: MR. PYEONG-SOO JUNG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	18052	TX

General Provider Information

NPI Number	:	1982612560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PYEONG-SOO JUNG LPC

Provider Business Mailing Address
First Line	:	3808 OAK MANOR CT
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6048
Country	:	US
Telephone Number	:	972-998-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 FOREST LN
Second Line	:	SUITE 112
City	:	DALLAS
State	:	TX
Zip	:	75234-7910
Country	:	US
Telephone Number	:	972-998-7015
Fax Number	:	214-352-1493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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