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General NPI Number Information
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NPI Number | 1013635036
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Entity Type | Individual
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Provider Name | SHUNTA LONG LPC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 440 BENMAR DR STE 2255
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City | HOUSTON
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State | TX
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Zip | 77060-3169
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Country | US
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Telephone | 281-272-1998
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Fax |
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Provider Business Mailing Address
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Address Line | 14555 PHILIPPINE ST APT 527
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City | HOUSTON
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State | TX
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Zip | 77040-7812
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Country | US
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Telephone | 713-320-2555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 115339
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 80063
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License Number State | TX
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