Provider Demographics
NPI:1386974889
Name:LONG, JAMIE L
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2152
Mailing Address - Country:US
Mailing Address - Phone:618-262-7473
Mailing Address - Fax:618-263-6579
Practice Address - Street 1:504 MICAH DR
Practice Address - Street 2:DRAWER M
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-4720
Practice Address - Country:US
Practice Address - Phone:618-395-4306
Practice Address - Fax:618-395-4507
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)