Provider Demographics
NPI:1427653526
Name:LONGHURST, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LONGHURST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 STARR COMMONWEALTH RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-9525
Mailing Address - Country:US
Mailing Address - Phone:517-629-5591
Mailing Address - Fax:
Practice Address - Street 1:19992 KELLY RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1919
Practice Address - Country:US
Practice Address - Phone:248-308-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist