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NPI Code Detail

MEDICARE: CHERYL INMON LONG PHD

MEDICARE: CHERYL INMON LONG PHD
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
1103T00000XPsychologist33455TX

General Provider Information

NPI Number : 1457676819
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL INMON LONG PHD
Provider Business Mailing Address
First Line : 1079 W ROUND GROVE RD STE 300-350
Second Line :
City : LEWISVILLE
State : TX
Zip : 75067-7905
Country : US
Telephone Number : 972-523-0200
Fax Number :
Provider Business Practice Location Address
First Line : 4221 MEDICAL PKWY STE 400
Second Line :
City : CARROLLTON
State : TX
Zip : 75010-4548
Country : US
Telephone Number : 972-523-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2010
Last Update Date : 09/20/2021

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