MEDICARE: LEE ROSS 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
1	101YP2500X	Professional Counselor	19393	TX

General Provider Information

NPI Number	:	1558367748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ROSS LONG LPC

Provider Business Mailing Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	STE OFFICE71
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	469-878-9967
Fax Number	:	214-890-4072

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	STE 500
City	:	DALLAS
State	:	TX
Zip	:	75231-3812
Country	:	US
Telephone Number	:	469-878-9967
Fax Number	:	214-890-4072

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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