Individual
MR. JEREMY DE WAYNE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH 11075
FL
101YP2500X
Professional Counselor
Primary
5617-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100057489
—
WI
Enumeration date
05/15/2012
Last updated
08/24/2020
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