Healthcare Provider Details

I. General information

NPI: 1992322903
Provider Name (Legal Business Name): JANAE KIM PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ARROW POINT DR SUITE 501 #TW127
CEDAR PARK TX
78613
US

IV. Provider business mailing address

1320 ARROW POINT DR SUITE 501 #TW127
CEDAR PARK TX
78613
US

V. Phone/Fax

Practice location:
  • Phone: 512-861-1743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JANAE KIM
Title or Position: LMFT
Credential: M.A.
Phone: 512-861-1743