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General NPI Number Information
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NPI Number | 1689926081
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Entity Type | Organization
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Legal Business Name | KATHRYN C LONGENBARGER
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 3554 SOUTH CUSTER ROAD
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City | MONROE
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State | MI
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Zip | 48161-9774
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Country | US
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Telephone | 734-770-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 845 TANNER LANDING
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City | MONROE
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State | MI
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Zip | 48161-4588
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Country | US
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Telephone | 734-770-2420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN C LONGENBARGER
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Credential | LLPC
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Telephone | 734-770-2420
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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 | 640102636
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License Number State | MI
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