MEDICARE: JENNIFER D LONG LMHC, MCAP

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	MH27141	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP100859	FL
3	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1245828730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER D LONG LMHC, MCAP

Provider Business Mailing Address
First Line	:	PO BOX 12919
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-0919
Country	:	US
Telephone Number	:	904-472-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-472-7233
Fax Number	:

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

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	01/16/2026

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