Long, Jeremy De Wayne

Long, Jeremy De Wayne is an individual health care provider with primary practice located at 870 Hollywood Blvd , West Melbourne FL 32904-7418. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Long, Jeremy De Wayne can be contacted via phone (800) 438-1772.

Contact Information

Primary practice address
870 Hollywood Blvd West Melbourne FL 32904-7418
Phone: (800) 438-1772
Fax: (262) 345-5562
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH 11075 Florida
Behavioral Health & Social Service Providers / Professional 101YP2500X 5617-125 Wisconsin

Profile Details

NPI number 1831458561
LBN Legal business name Long, Jeremy De Wayne
Credentials LMHC, LPC
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2012
Last updated Aug 24th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831458561 NPPES
Wisconsin MEDICAID 100057489

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