Healthcare Provider Details

I. General information

NPI: 1285161844
Provider Name (Legal Business Name): KRISTI LONGLEY M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 FM 902
LAKE KIOWA TX
76240-8483
US

IV. Provider business mailing address

3029 SOLANA CIR
DENTON TX
76207-1466
US

V. Phone/Fax

Practice location:
  • Phone: 325-669-9811
  • Fax:
Mailing address:
  • Phone: 325-669-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: