Active NPI
Brian Timothy Long, PHD
- Mental Health Counselor
- Elizabethtown, KY
National Provider Identifier
1962023879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 262683
- Practice address
- 413 E Dixie Ave Ste 106
Elizabethtown, KY 42701-1162 - Phone
- (270) 319-9899
- NPI assigned
- May 1, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 262683 | KY | Primary |
Addresses
Primary practice location
413 E Dixie Ave Ste 106
Elizabethtown, KY 42701-1162
Mailing address
168 E Vine St
Radcliff, KY 40160-2684
Phone (704) 880-6124
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 |
|---|---|---|---|
| 262683 | KY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588550400000",
"number": "1962023879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "168 E VINE ST",
"city": "RADCLIFF",
"state": "KY",
"postal_code": "401602684",
"telephone_number": "704-880-6124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 E DIXIE AVE STE 106",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427011162",
"telephone_number": "270-319-9899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "BRIAN",
"middle_name": "TIMOTHY",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-01",
"last_updated": "2020-05-04",
"certification_date": "2020-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "KY",
"license": "262683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.