NPI Code Detail JSON Logo

1073483947 NPI number — MACK C LONG III

NPI Number: 1073483947
Health Care Provider/Practitioner: MACK C LONG III

Information about “1073483947” NPI (MACK C LONG III) exists in 1073483947 in HTML format HTML  |  1073483947 in plain Text format TXT  |  1073483947 in PDF (Portable Document Format) PDF  |  1073483947 in an XML format XML  formats.

NPI Number : 1073483947 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073483947",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LONG",
    "FirstName": "MACK",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": "III",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "334 COUNTY ROAD 3909",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAWKINS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75765-4000",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-604-2436",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "703 W PATTEN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MINEOLA",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75773-1541",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "903-535-7344",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/06/2025",
    "LastUpdateDate": "11/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "15950",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "91528",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "91528",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.