Provider Demographics
NPI:1710708052
Name:LONG, CHRISTA (MED, LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MED, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 FM 2126
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-3908
Mailing Address - Country:US
Mailing Address - Phone:432-413-7681
Mailing Address - Fax:
Practice Address - Street 1:114 CENTER AVE STE 203
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3172
Practice Address - Country:US
Practice Address - Phone:325-532-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health