Provider Demographics
NPI:1982855235
Name:LONGORIA, KIRA ANN (MS ED, LPC)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:ANN
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:MS ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 HISTORIC 66 W
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2136
Mailing Address - Country:US
Mailing Address - Phone:833-338-4673
Mailing Address - Fax:
Practice Address - Street 1:704 HISTORIC 66 W
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2136
Practice Address - Country:US
Practice Address - Phone:833-338-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MO2021011819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator