Teresa Nicole Long

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

99095605A Issued in IN

Practice address

1715 N Granville Ave Ste C
Muncie, IN 47303-2149

Phone

(765) 717-1403

NPI assigned

Nov 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Hope Chest Tikkun Olam Center LLC

  • Social Worker
  • Muncie, IN
  • NPI 1205434107
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1740825488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 N GRANVILLE AVE STE C",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473032149",
            "telephone_number": "765-717-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 N GRANVILLE AVE STE C",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473032149",
            "telephone_number": "765-717-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "TERESA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "99095605A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Byron Long, PH.D.
• Edward C Long III
• Jarius T Long
• Jayden Derel Long
• Jordan Long
• Betsy K Longnecker, CFNP
• Elaina Gabrielle Lopez, FNP-C
• Hannah Marie Lopez, LSW
• Joseph James Lopez, M.D.
• Daniel C Lopiccolo, M.D.

• Mental Health Counselor in Muncie, IN
• Providers in Muncie, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.