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NPI Code Detail

MEDICARE: MR. JAMES KENNETH LONG LPC

MEDICARE: MR. JAMES KENNETH 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
1101YM0800XMental Health Counselor001941MO
2101YP2500XProfessional Counselor001941MO
3106H00000XMarriage & Family Therapist001941MO

General Provider Information

NPI Number : 1336135722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES KENNETH LONG LPC
Provider Business Mailing Address
First Line : 3100 BROADWAY ST
Second Line : STE 1104
City : KANSAS CITY
State : MO
Zip : 64111-2658
Country : US
Telephone Number : 816-516-2127
Fax Number : 816-753-7744
Provider Business Practice Location Address
First Line : 101 NW ENGLEWOOD RD
Second Line : C/O JAMES KENNETH LONG
City : GLADSTONE
State : MO
Zip : 64118-4063
Country : US
Telephone Number : 816-516-2127
Fax Number : 816-753-7744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 09/11/2025

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