MEDICARE: CHIGUITA S LONG MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891033700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIGUITA S LONG MS

Provider Business Mailing Address
First Line	:	302 N JACKSON ST
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-2504
Country	:	US
Telephone Number	:	662-323-9318
Fax Number	:	662-323-5553

Provider Business Practice Location Address
First Line	:	1032 STATE HWY 50 W
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-1336
Country	:	US
Telephone Number	:	662-524-4347
Fax Number	:	662-524-4364

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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Directions to “ CHIGUITA S LONG MS” Practice Location

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