Provider Demographics
NPI:1194750430
Name:LONG, JANA REDDIN (PHD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:REDDIN
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 NORTH CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5620
Mailing Address - Country:US
Mailing Address - Phone:972-547-4849
Mailing Address - Fax:972-692-8870
Practice Address - Street 1:1216 NORTH CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5620
Practice Address - Country:US
Practice Address - Phone:972-547-4849
Practice Address - Fax:972-692-8870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3 1541103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00215PMedicare ID - Type UnspecifiedMEDICARE