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NPI 1962123406

NPI 1962123406 : AUBREY ELIZABETH LONG : INDIANAPOLIS, IN

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General NPI Number Information
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    NPI Number           |    1962123406
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    Entity Type          |    Individual 
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    Provider Name        |    AUBREY ELIZABETH LONG
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    09/02/2022
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    Last Update Date     |    01/02/2026
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Provider Practice Location Address
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    Address Line         |    8401 HARCOURT RD 
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    City                 |    INDIANAPOLIS
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    State                |    IN
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    Zip                  |    46260-2036
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    Country              |    US
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    Telephone            |    317-338-4850
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    Fax                  |    317-338-4890
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Provider Business Mailing Address
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    Address Line         |    8401 HARCOURT RD 
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    City                 |    INDIANAPOLIS
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    State                |    IN
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    Zip                  |    46260-2036
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    Country              |    US
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    Telephone            |    317-338-4850
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    Fax                  |    317-338-4890
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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        |    1041C0700X
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    Taxonomy Name        |    Clinical Social Worker
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    License Number       |    34012167A
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    License Number State |    IN
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Taxonomy #2
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    Taxonomy Code        |    251S00000X
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    Taxonomy Name        |    Community/Behavioral Health Agency
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    License Number       |    
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    License Number State |    
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