Provider Demographics
NPI:1336955780
Name:SOUL BRIDGE MINISTRY
Entity type:Organization
Organization Name:SOUL BRIDGE MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-255-2836
Mailing Address - Street 1:4801 WITTEN PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8670
Mailing Address - Country:US
Mailing Address - Phone:337-255-2836
Mailing Address - Fax:469-727-5593
Practice Address - Street 1:6136 FRISCO SQUARE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3251
Practice Address - Country:US
Practice Address - Phone:337-255-2836
Practice Address - Fax:469-727-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty