Provider Demographics
NPI:1265499040
Name:LONG, JULIE STEVENS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:STEVENS
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:KRITSELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084
Mailing Address - Country:US
Mailing Address - Phone:636-583-7738
Mailing Address - Fax:636-583-6745
Practice Address - Street 1:104 S MCKINLEY
Practice Address - Street 2:SUITE D
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084
Practice Address - Country:US
Practice Address - Phone:636-583-7738
Practice Address - Fax:636-583-6745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170897104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO157940OtherBLUE CROSS BLUE SHIELD
MO78719Medicare ID - Type Unspecified