Provider Demographics
NPI:1093147506
Name:LONG, KRISTI D (NCC, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:NCC, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3067
Mailing Address - Country:US
Mailing Address - Phone:936-521-6369
Mailing Address - Fax:936-756-8565
Practice Address - Street 1:1020 RIVERWOOD CT
Practice Address - Street 2:BLDG. 3
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2811
Practice Address - Country:US
Practice Address - Phone:936-521-6369
Practice Address - Fax:936-756-8565
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12156101YA0400X
TX71315101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health