Provider Demographics
NPI:1558667360
Name:LONG, KRISTINA M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-4729
Mailing Address - Country:US
Mailing Address - Phone:701-683-5086
Mailing Address - Fax:701-683-4999
Practice Address - Street 1:1006 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4729
Practice Address - Country:US
Practice Address - Phone:701-683-5086
Practice Address - Fax:701-683-4999
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND25-3-8-91101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health