Jeremy De Wayne Long, LMHC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5617-125 Issued in WI

Practice address

870 Hollywood Blvd
West Melbourne, FL 32904-7418

Phone

(800) 438-1772

Fax

(262) 345-5562

NPI assigned

May 15, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 2, 2025 through Sep 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Livewell Behavioral Health Corp

  • Mental Health Counselor
  • Melbourne, FL
  • NPI 1770185308
  NPD (past)
• Wisconsin Lutheran Child & Family Service

  • Mental Health Counselor
  • West Melbourne, FL
  • NPI 1447702956
  NPD (past)

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1831458561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 TEJON AVE SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329087437",
            "telephone_number": "321-482-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 HOLLYWOOD BLVD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329047418",
            "telephone_number": "800-438-1772",
            "fax_number": "262-345-5562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "690 Friday Rd",
            "address_purpose": "LOCATION",
            "city": "Cocoa",
            "state": "FL",
            "postal_code": "329263317",
            "country_code": "US",
            "telephone_number": "321-636-9941",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "W175N11120 Stonewood Dr",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "WI",
            "postal_code": "530224799",
            "country_code": "US",
            "telephone_number": "800-438-1772",
            "fax_number": "262-345-5562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "JEREMY",
        "middle_name": "DE WAYNE",
        "name_prefix": "Mr.",
        "credential": "LMHC, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-15",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH 11075",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5617-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100057489",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Lewis
• Robert Lightner
• Lina Kanj MD PA
• Angela K Little, SLP-A
• Lindsay Logan, MSW
• Kelly Luther
• Luxottica of America Inc.
• Catherine Maccasland, PHARMD
• Erica Magallenes
• Candice Malekian

• Professional Counselor in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Professional Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.