| Doctor Name: | JEANINE LONG |
| NPI Number: | 1013138957 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 2237 |
| Business Practice Address: | 4425 W Zoo Blvd Suite 3 Wichita, KS - 672121620 |
| Business Phone Number: | 3167492007 |
| Business Fax Number: | 3169435554 |
| Mailing Address: | 701 E 1st St N Apt 206, Suite A WICHITA |
| State: | KS |
| Postal Code: | 672024905 |
| Phone Number: | 3162597018 |
| Fax Number: | 3166860036 |
| NPI Enumeration Date: | 05/01/2007 |
| NPI Last Update Date: | 03/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2237 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |