Provider Demographics
NPI:1558646539
Name:LONGENBARGER, KATHRYN COLLEEN (LLPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COLLEEN
Last Name:LONGENBARGER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MONROE ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2468
Mailing Address - Country:US
Mailing Address - Phone:734-682-3445
Mailing Address - Fax:
Practice Address - Street 1:25 S MONROE ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2468
Practice Address - Country:US
Practice Address - Phone:734-682-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional