Active NPI
Louise Knight-Long, LSW
- Mental Health Counselor
- Tobyhanna, PA
National Provider Identifier
1063986008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 136797
- Practice address
- 4 Fork Street
Suite 13080, Third Floor
Tobyhanna, PA 18344 - Phone
- (570) 580-1115
- Fax
- (570) 580-1120
- NPI assigned
- Jan 13, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 136797 | PA | Primary |
Addresses
Primary practice location
4 Fork Street
Suite 13080, Third Floor
Tobyhanna, PA 18344
Mailing address
4 Fork Street
Suite 13080, Third Floor
Tobyhanna, PA 18344
Phone (570) 580-1115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497229421 | Other | PA | MINDBRIDGE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136797 | PA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindbridge Group, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586304000000",
"number": "1063986008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 FORK STREET",
"address_2": "SUITE 13080, THIRD FLOOR",
"city": "TOBYHANNA",
"state": "PA",
"postal_code": "18344",
"telephone_number": "570-580-1115",
"fax_number": "570-580-1120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 FORK STREET",
"address_2": "SUITE 13080, THIRD FLOOR",
"city": "TOBYHANNA",
"state": "PA",
"postal_code": "18344",
"telephone_number": "570-580-1115",
"fax_number": "570-580-1120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNIGHT-LONG",
"first_name": "LOUISE",
"name_prefix": "Ms.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-13",
"last_updated": "2020-04-08",
"certification_date": "2020-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "136797",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINDBRIDGE",
"identifier": "1497229421",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tobyhanna, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.