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General NPI Number Information
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NPI Number | 1255808176
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Entity Type | Individual
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Provider Name | JERI KAY LONG-KAO LPC, MA MFT
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Gender | Female
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 206 N STATE ST STE 209
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City | DECATUR
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State | TX
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Zip | 76234-1444
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Country | US
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Telephone | 940-577-1848
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | DECATUR
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State | TX
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Zip | 76234-0477
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Country | US
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Telephone | 940-577-1848
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 77201
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License Number State | TX
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