Provider Demographics
NPI:1245094283
Name:LONG, JARIUS T
Entity type:Individual
Prefix:
First Name:JARIUS
Middle Name:T
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N. BLAINE ST
Mailing Address - Street 2:MUNCIE
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303
Mailing Address - Country:US
Mailing Address - Phone:765-716-1556
Mailing Address - Fax:
Practice Address - Street 1:1715 N GRANVILLE AV MUNCIE IN 47303
Practice Address - Street 2:MUNCIE STE C
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:765-212-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor