MEDICARE: KINGDOM BRIDGE, INC.

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

General Provider Information

NPI Number	:	1932058682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM BRIDGE, INC.

Provider Business Mailing Address
First Line	:	609 S KELLY AVE STE C1
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5743
Country	:	US
Telephone Number	:	405-697-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 S KELLY AVE STE C
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5659
Country	:	US
Telephone Number	:	405-697-0203
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	CALEB MCKEAN
Credential	:	LPC
Telephone Number	:	405-696-7636

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “KINGDOM BRIDGE, INC. ” Practice Location

Language	Start Address	Practice Location

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