Provider Demographics
NPI:1518327873
Name:LONG, MICHELLE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21473 COUNTY ROAD 74 # 55
Mailing Address - Street 2:
Mailing Address - City:PEETZ
Mailing Address - State:CO
Mailing Address - Zip Code:80747-9611
Mailing Address - Country:US
Mailing Address - Phone:970-520-9064
Mailing Address - Fax:
Practice Address - Street 1:216 N 3RD ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4302
Practice Address - Country:US
Practice Address - Phone:970-526-6577
Practice Address - Fax:970-965-0059
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional