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NPI Code Detail

MEDICARE: COLLEEN C O'GRADY-LONG LPC

MEDICARE: COLLEEN C O'GRADY-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
1106H00000XMarriage & Family Therapist11315TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
283062LOTHERTXBCBS

General Provider Information

NPI Number : 1447284468
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN C O'GRADY-LONG LPC
Provider Business Mailing Address
First Line : PO BOX 201088
Second Line :
City : HOUSTON
State : TX
Zip : 77216-1088
Country : US
Telephone Number : 713-500-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1300 MOURSUND ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-3406
Country : US
Telephone Number : 713-500-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 06/17/2008

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Directions to “ COLLEEN C O'GRADY-LONG LPC” Practice Location

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