MEDICARE: DR. CARRIE A LONGEST LMHC

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	MH9100	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689845414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE A LONGEST LMHC

Provider Business Mailing Address
First Line	:	12300 S SHORE BLVD STE 222
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6509
Country	:	US
Telephone Number	:	561-473-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	12300 S SHORE BLVD STE 222
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6509
Country	:	US
Telephone Number	:	561-473-4219
Fax Number	:

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	06/18/2023

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