MEDICARE: SHUNTA LONG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	115339	TX
2	101YP2500X	Professional Counselor	80063	TX

General Provider Information

NPI Number	:	1013635036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNTA LONG LPC

Provider Business Mailing Address
First Line	:	14555 PHILIPPINE ST APT 527
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-7812
Country	:	US
Telephone Number	:	713-320-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 BENMAR DR STE 2255
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3169
Country	:	US
Telephone Number	:	281-272-1998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	03/31/2025

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Directions to “ SHUNTA LONG LPC” Practice Location

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