MEDICARE: JENNIFER LEE KIM LPC ASSOCIATE

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	101YM0800X	Mental Health Counselor	88049	TX

General Provider Information

NPI Number	:	1245756527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEE KIM LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	1600 S LAKELINE BLVD APT 1534
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-2023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4408 SPICEWOOD SPRINGS RD STE 111
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8504
Country	:	US
Telephone Number	:	512-655-3878
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	05/10/2022

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