| Doctor Name: | MRS. HAZEL LONG |
| NPI Number: | 1336508415 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISAC |
| License Number: | 11544 |
| Business Practice Address: | 483 W. Seed Farm Rd. Sacaton, AZ - 851470001 |
| Business Phone Number: | 6025281200 |
| Business Fax Number: | 6025281374 |
| Mailing Address: | Po Box 38, SACATON |
| State: | AZ |
| Postal Code: | 851470001 |
| Phone Number: | 6025281200 |
| Fax Number: | 6025281374 |
| NPI Enumeration Date: | 02/17/2016 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11544 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |