MEDICARE: JULIE KAY LONGLEY MFT

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	106H00000X	Marriage & Family Therapist	0858	NV

General Provider Information

NPI Number	:	1528275419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KAY LONGLEY MFT

Provider Business Mailing Address
First Line	:	7331 W CHARLESTON BLVD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1570
Country	:	US
Telephone Number	:	702-233-1119
Fax Number	:	702-228-9111

Provider Business Practice Location Address
First Line	:	7331 W CHARLESTON BLVD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1570
Country	:	US
Telephone Number	:	702-233-1119
Fax Number	:	702-228-9111

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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