Provider Demographics
NPI:1720362841
Name:M LONGLEY COUNSELING AND CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:M LONGLEY COUNSELING AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LONGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCSW
Authorized Official - Phone:269-687-5050
Mailing Address - Street 1:333 N 2ND ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2258
Mailing Address - Country:US
Mailing Address - Phone:269-687-5050
Mailing Address - Fax:269-687-5050
Practice Address - Street 1:333 N 2ND ST
Practice Address - Street 2:SUITE 303
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2258
Practice Address - Country:US
Practice Address - Phone:269-687-5050
Practice Address - Fax:269-687-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM13409Medicare PIN