Provider Demographics
NPI:1902938442
Name:FURLONG, ADIELLE NICHOLE (LPC)
Entity Type:Individual
Prefix:
First Name:ADIELLE
Middle Name:NICHOLE
Last Name:FURLONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19905 E. 47TH STREET DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015
Mailing Address - Country:US
Mailing Address - Phone:816-678-6586
Mailing Address - Fax:
Practice Address - Street 1:400 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3703
Practice Address - Country:US
Practice Address - Phone:816-741-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004036878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional