Doctor Name: | TODD LONG |
NPI Number: | 1205201894 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1108 N Wheeler Ave Sallisaw, OK - 749552227 |
Business Phone Number: | 9187755513 |
Business Fax Number: | |
Mailing Address: | Rr 4 Box 1370, SALLISAW |
State: | OK |
Postal Code: | 749559651 |
Phone Number: | 9183153601 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2015 |
NPI Last Update Date: | 12/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |