Provider Demographics
NPI:1558367748
Name:LONG, LEE ROSS (LPC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ROSS
Last Name:LONG
Suffix:
Gender:M
Credentials:LPC
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Mailing Address - Street 1:7502 GREENVILLE AVE
Mailing Address - Street 2:STE OFFICE71
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3832
Mailing Address - Country:US
Mailing Address - Phone:469-878-9967
Mailing Address - Fax:214-890-4072
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:STE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3812
Practice Address - Country:US
Practice Address - Phone:469-878-9967
Practice Address - Fax:214-890-4072
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX19393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional