Provider Demographics
NPI:1255808176
Name:LONG-KAO, JERI KAY (LPC, MA MFT)
Entity type:Individual
Prefix:MS
First Name:JERI
Middle Name:KAY
Last Name:LONG-KAO
Suffix:
Gender:F
Credentials:LPC, MA MFT
Other - Prefix:MS
Other - First Name:JERI
Other - Middle Name:KAY
Other - Last Name:KAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, MA MFT
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-0477
Mailing Address - Country:US
Mailing Address - Phone:940-577-1848
Mailing Address - Fax:
Practice Address - Street 1:206 N STATE ST STE 209
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1444
Practice Address - Country:US
Practice Address - Phone:940-577-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional