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Organization
KEITH LONG, LPC, LLC
Active
Organization
KEITH LONG, LPC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH DAVID LONG LPC (LICENSED PROFESSIONAL COUNSELOR)
(303) 750-5435
Entity
Organization
Contact information
Practice address
2323 S TROY ST, BLDG. 3, SUITE 108, AURORA, CO 80014-1946
(303) 750-5435
(303) 750-5435
Mailing address
9085 E MISSISSIPPI AVE, APT N107, DENVER, CO 80247-4009
(303) 750-5435
(303) 750-5435
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC.0003080
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942327895
MEDICAID INDIVIDUAL NPI
CO
Enumeration date
09/02/2016
Last updated
09/21/2016
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