Doctor Name: | MRS. MELISSA JO LONG |
NPI Number: | 1407029606 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPE |
License Number: | 06-11E |
Business Practice Address: | 65 E Main St Greenbrier, AR - 720589121 |
Business Phone Number: | 5014280476 |
Business Fax Number: | |
Mailing Address: | 65 E Main St, GREENBRIER |
State: | AR |
Postal Code: | 720589121 |
Phone Number: | 5014280476 |
Fax Number: | |
NPI Enumeration Date: | 04/08/2008 |
NPI Last Update Date: | 04/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 06-11E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |