person
Mr. Jeremy De Wayne Long, LMHC,LPC
Professional Counselor in West Melbourne, Florida
NPI 1831458561

Jeremy De Wayne Long is a Professional Counselor based in Palm Bay, FL and is specialized in Professional. Jeremy De Wayne Long practices in West Melbourne, FL and has the professional credentials of LMHC,LPC. The NPI Number for Jeremy De Wayne Long is 1831458561 and holds a License No. MH 11075 (Florida).

The current practice location address for Jeremy De Wayne Long is 870 Hollywood Blvd, West Melbourne, FL and can be reached out via phone at 800-438-1772 and via fax at 262-345-5562.

Location: 870 Hollywood Blvd, West Melbourne, FL, 32908-7437
person
Provider Profile Details
NPI Number
1831458561
Provider Name
Jeremy De Wayne Long
Credential
LMHC,LPC
Provider Entity Type
Individual
Gender
Male
Address
870 Hollywood Blvd, West Melbourne, FL, 32908-7437
Phone Number
800-438-1772
Fax Number
262-345-5562
Provider Enumeration Date
05/15/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100057489 05 WI
institution
Provider Business Practice Location Address Details
Address
870 Hollywood Blvd
City
State
Zip
32904-7418
Phone Number
800-438-1772
Fax Number
262-345-5562
person
Provider Business Mailing Address Details
Address
870 Hollywood Blvd
City
State
Zip
32904-7418
Phone Number
800-438-1772
Fax Number
262-345-5562
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
5617-125 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
MH 11075 (Florida)
Definition
Definition to come...
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