Provider Information for 1013635036
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SHUNTA LONG LPC
Sex: Female
NPI: 1013635036
Last Updated: 2025-03-31
Certification Date: 2025-03-31
Certification Date: 2025-03-31
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013635036 | ||||||||||||
| Enumeration Date | 2022-08-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 14555 PHILIPPINE ST APT 527 HOUSTON, TX 77040-7812 United States Phone: 713-320-2555 | Fax: | ||||||||||||
| Primary Practice Address | 440 BENMAR DR STE 2255 HOUSTON, TX 77060-3169 United States Phone: 281-272-1998 | Fax: | ||||||||||||
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