Provider Demographics
NPI:1457676819
Name:INMON LONG, CHERYL (PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:INMON LONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 W ROUND GROVE RD STE 300-350
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7905
Mailing Address - Country:US
Mailing Address - Phone:972-523-0200
Mailing Address - Fax:
Practice Address - Street 1:4221 MEDICAL PKWY STE 400
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4548
Practice Address - Country:US
Practice Address - Phone:972-523-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist