Healthcare Provider Details

I. General information

NPI: 1366988164
Provider Name (Legal Business Name): SHARON LONG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 CREEKVIEW LN
CRANDALL TX
75114-5105
US

IV. Provider business mailing address

147 CREEKVIEW LN
CRANDALL TX
75114-5105
US

V. Phone/Fax

Practice location:
  • Phone: 214-796-1706
  • Fax:
Mailing address:
  • Phone: 214-796-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: