Edgar Charles John Long, PH.D.

Primary specialty

Family PsychologistTaxonomy code 103TF0000X

License

4101005371 Issued in MI

Practice address

2163 Cornerstone Dr
Mt Pleasant, MI 48858-8029

Phone

(989) 330-2417

NPI assigned

Nov 23, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1542931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542931200000",
    "number": "1902375652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2163 CORNERSTONE DR",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488588029",
            "telephone_number": "989-330-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2163 CORNERSTONE DR",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488588029",
            "telephone_number": "989-330-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "EDGAR",
        "middle_name": "CHARLES JOHN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-23",
        "last_updated": "2018-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Family",
            "state": "MI",
            "license": "4101005371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Howard Locke, DPT, AT, ATC
• Jaelin M Lockwood
• Hannah Logan, LPN
• Jill Lohman
• Blaine Long, ATC
• John Joseph Longmore Jr., PTA
• Jordyn E Loomis, PTA
• John Edward Lopes Jr., PA-C
• Amanda Lee Lopez, PH.D
• Rachael Marie Lorenz

• Family Psychologist in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Family Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2018; 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.