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General NPI Number Information
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NPI Number | 1336955780
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Entity Type | Organization
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Legal Business Name | SOUL BRIDGE MINISTRY
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 6136 FRISCO SQUARE BLVD STE 400
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City | FRISCO
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State | TX
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Zip | 75034-3251
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Country | US
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Telephone | 337-255-2836
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Fax | 469-727-5593
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Provider Business Mailing Address
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Address Line | 4801 WITTEN PARK WAY
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City | MCKINNEY
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State | TX
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Zip | 75070-8670
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Country | US
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Telephone | 337-255-2836
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Fax | 469-727-5593
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Authorized Official
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Title or Position | BOARD DIRECTOR
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Name | JOEL QIAO
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Credential | LPC
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Telephone | 337-255-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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