MEDICARE: JULIE LONG LMTP, BCMT

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	171400000X	Health & Wellness Coach
2	174H00000X	Health Educator
3	225600000X	Dance Therapist
4	225800000X	Recreation Therapist
5	251E00000X	Home Health Agency
6	3747A0650X	Attendant Care Provider
7	385H00000X	Respite Care
8	225700000X	Massage Therapist	0019003869	VA

General Provider Information

NPI Number	:	1225801624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LONG LMTP, BCMT

Provider Business Mailing Address
First Line	:	3481 HOWARD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1429
Country	:	US
Telephone Number	:	804-726-0197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 DELMONICO DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2532
Country	:	US
Telephone Number	:	804-212-2698
Fax Number	:

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

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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