=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871459537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUMP THE BROOM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2025
-----------------------------------------------------
Last Update Date | 12/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1296 FRANKLIN AVE STE 201
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-219-9496
-----------------------------------------------------
Fax | 614-802-5249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1296 FRANKLIN AVE STE 201
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-219-9496
-----------------------------------------------------
Fax | 614-802-5249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GABRIEL M BURKE
-----------------------------------------------------
Credential | MSW, LISW-S, LCSW
-----------------------------------------------------
Telephone | 614-219-9496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------