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General NPI Number Information
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NPI Number | 1639958655
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Entity Type | Individual
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Provider Name | JADA ALEXIS LONG LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 8530 FM 1960 RD E STE 214
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City | HUMBLE
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State | TX
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Zip | 77346-1831
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Country | US
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Telephone | 346-297-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 5919 STIRRING WINDS LN
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City | HOUSTON
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State | TX
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Zip | 77086-2943
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Country | US
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Telephone | 346-814-5858
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 111231
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License Number State | TX
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