=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902938442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADIELLE NICHOLE FURLONG LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2007
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 E 6TH ST
-----------------------------------------------------
City | PARKVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64152-3703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-741-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19905 E. 47TH STREET DRIVE
-----------------------------------------------------
City | BLUE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-678-6586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2004036878
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------