MR. SHANE RAYMOND LONG (NPI# 1447521356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447521356 |
| Entity Type | Individual |
| Full Name | MR. SHANE RAYMOND LONG |
| Credential | L.M.F.T. |
| Practice Address |
516 Mission House Ln New Brighton MN 55112-2571 |
| Practice Telephone | 6516365120 |
| Practice Fax Number | 6516365124 |
| Mailing Telephone | 6516365120 |
| Mailing Fax Number | 6516365124 |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 2462 | MN | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275640831 | Shane Patrick Long | Social Worker | Kaiser Sunnyside Medical Office, 10180 Se Sunnyside Rd, Clackamas, OR 97015-9764 | 2006-08-23 |
| Street Address |
516 MISSION HOUSE LN |
| City | NEW BRIGHTON |
| State | MN |
| Zip Code | 55112-2571 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164711735 | North Central Ministry Development Center, Inc. | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-04-04 |
| 1417558321 | Daniel Elenz | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2020-11-06 |
| 1356826325 | Kelly Jordan | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2018-09-26 |
| 1124408570 | Marina Rosenthal | Counselor | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2015-06-01 |
| 1801161641 | Caroline A Burke | Specialist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2012-03-13 |
| 1033401542 | Mary Lou Honstead | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-05-03 |
| 1710278502 | Mark Elmer Sundby | Psychologist | 516 Mission House Ln, New Brighton, MN 55112-2571 | 2011-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1245781608 | Evan Fredrick Lieberman | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2016-10-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932679883 | Kimberly Kay Navarre | Marriage & Family Therapist | 1900 Silver Lake Rd Nw Ste 210, New Brighton, MN 55112-1786 | 2018-12-03 |
| 1194235663 | Jay Scott Sidor | Marriage & Family Therapist | 2475 15th St Nw Ste D, New Brighton, MN 55112-5606 | 2017-10-10 |
| 1740681253 | Timothy L. Kuss | Marriage & Family Therapist | 1575 Long Lake Rd, New Brighton, MN 55112-5577 | 2014-09-16 |
| 1780206888 | Stacy Smith Donley | Marriage & Family Therapist | 900 Long Lake Rd, New Brighton, MN 55112-6428 | 2020-05-12 |
| 1295373728 | Well-being for Kids, LLC | Marriage & Family Therapist | 900 Long Lake Rd Ste 320, New Brighton, MN 55112-6439 | 2019-12-16 |
| 1548822943 | Health and Wellness Collaborative | Marriage & Family Therapist | 900 Long Lake Rd Ste 160, New Brighton, MN 55112-6414 | 2019-07-05 |
| 1639645898 | Lynanne Evenson | Marriage & Family Therapist | 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 | 2018-10-15 |
| 1275044018 | Sarah Catherine Lucas Bowman | Marriage & Family Therapist | 2475 15th St Nw Ste D, New Brighton, MN 55112-5606 | 2017-10-19 |
| 1760935282 | Katie Hermerding | Marriage & Family Therapist | 1900 Silver Lake Road Nw, Suite 110, New Brighton, MN 55112 | 2016-08-02 |
| 1912371758 | Quo Vadis Therapy Center, LLC | Marriage & Family Therapist | 900 Long Lake Rd Ste 320, New Brighton, MN 55112-6439 | 2015-11-17 |
| Find all providers in NEW BRIGHTON | ||||
| City | NEW BRIGHTON |
| Zip Code | 55112 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.