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MR. JEREMY DE WAYNE LONG LMHC, LPC
NPI 1831458561
Counselor - Professional in West Melbourne, FL

Active since May 15, 2012Opted out of Medicare · through Sep 2, 2027
870 HOLLYWOOD BLVD, WEST MELBOURNE, FL 32904(800) 438-1772(262) 345-5562 Get Directions Write a Review

NPPES record last updated: August 24, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mr. Jeremy De Wayne Long Lmhc, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JEREMY DE WAYNE LONG LMHC, LPC (NPI 1831458561) is an individual professional provider in West Melbourne, Florida, licensed in Wisconsin (5617-125) and active in the NPI registry since May 2012. He has opted out of Medicare through September 2, 2027 and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1831458561
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMR. JEREMY DE WAYNE LONGCredential: LMHC, LPC
Location Address870 HOLLYWOOD BLVDWest Melbourne, FL 32904-7418
Mailing Address630 Tejon Ave SwPalm Bay, FL 32908-7437 · (321) 482-9492
Phone(800) 438-1772
Fax(262) 345-5562
Sole ProprietorNo
Enumeration DateMay 15, 2012
Last NPPES UpdateAugust 24, 2020
NPPES CertifiedAugust 24, 2020
✔ NPI 1831458561 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in WI · 5617-125
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License MH 11075 (FL)
870 HOLLYWOOD BLVD, West Melbourne, FL 32904
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1W175N11120 Stonewood DrGermantown, WI 53022-4799 · Phone (800) 438-1772 · Fax (262) 345-5562
Location 2690 Friday RdCocoa, FL 32926-3317 · Phone (321) 636-9941

Other Identifiers 1

Medicaid100057489WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mr. Jeremy De Wayne Long Lmhc, Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 2, 2025 through September 2, 2027.

Opt-Out Effective DateSeptember 2, 2025
Opt-Out In Effect ThroughSeptember 2, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WISCONSIN LUTHERAN CHILD & FAMILY SERVICE
Counselor (Mental Health)
870 HOLLYWOOD BLVD
WEST MELBOURNE, FL 32904
Brevard County (800) 438-1772

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeremy Long's NPI number?

The NPI number for Jeremy Long is 1831458561. It was assigned to this individual provider in the NPPES registry on May 15, 2012.

Where is Jeremy Long located?

Jeremy Long practices at 870 Hollywood Blvd, West Melbourne, FL 32904. The listed phone number is (800) 438-1772.

What is Jeremy Long's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jeremy Long enrolled in Medicare?

No. Jeremy Long has opted out of Medicare through September 2, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jeremy Long was last updated on August 24, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.