Provider Demographics
NPI:1780156471
Name:LONG, MEGAN NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
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 1:110 BEAUREGARD LN S
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3629
Mailing Address - Country:US
Mailing Address - Phone:504-914-3067
Mailing Address - Fax:
Practice Address - Street 1:654 BROCKENBRAUGH CT
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2712
Practice Address - Country:US
Practice Address - Phone:504-914-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6898101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor