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General NPI Number Information
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NPI Number | 1518327873
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Entity Type | Individual
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Provider Name | MICHELLE MARIE LONG LPC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 216 N 3RD ST
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City | STERLING
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State | CO
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Zip | 80751-4302
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Country | US
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Telephone | 970-526-6577
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Fax | 970-965-0059
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Provider Business Mailing Address
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Address Line | 21473 COUNTY ROAD 74 # 55
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City | PEETZ
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State | CO
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Zip | 80747-9611
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Country | US
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Telephone | 970-520-9064
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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 | LPC.0012007
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License Number State | CO
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