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General NPI Number Information
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NPI Number | 1720747322
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Entity Type | Individual
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Provider Name | EDWARD C LONG III
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Gender | Male
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 1715 N GRANVILL AVE SUITE C MUNCIE
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City | MUNCIE
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State | IN
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Zip | 47303-4730
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Country | US
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Telephone | 765-749-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N BLAINE ST
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City | MUNCIE
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State | IN
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Zip | 47303-5006
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Country | US
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Telephone | 765-716-1556
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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