Active NPI
Shelley Lynn Long, PH.D.
- Counseling Psychologist
- Roanoke, TX
National Provider Identifier
1144772567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 36498
- Practice address
- 325 Oxford CT
Roanoke, TX 76262-5063 - Phone
- (979) 571-5046
- NPI assigned
- Nov 2, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 19815 | TX | |
| Counseling Psychologist | 103TC1900X | 36498 | TX | Primary |
Addresses
Primary practice location
325 Oxford CT
Roanoke, TX 76262-5063
Mailing address
325 Oxford CT
Roanoke, TX 76262-5063
Phone (979) 571-5046
Other names 1
- Shelley Lynn Peters
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36498 | TX | MD | Counseling Psychologist |
| 19815 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478044800000",
"number": "1144772567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 OXFORD CT",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762625063",
"telephone_number": "979-571-5046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 OXFORD CT",
"city": "ROANOKE",
"state": "TX",
"postal_code": "762625063",
"telephone_number": "979-571-5046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "SHELLEY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-02",
"last_updated": "2016-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "19815",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "TX",
"license": "36498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHELLEY",
"last_name": "PETERS",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Roanoke, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.