Provider Demographics
NPI:1083182802
Name:LONGPRE, ERICH JOSEPH (MS)
Entity type:Individual
Prefix:MR
First Name:ERICH
Middle Name:JOSEPH
Last Name:LONGPRE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 E REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-8529
Mailing Address - Country:US
Mailing Address - Phone:208-660-2995
Mailing Address - Fax:
Practice Address - Street 1:2243 E REMINGTON RD
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-8529
Practice Address - Country:US
Practice Address - Phone:208-304-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60819606101Y00000X
ID2961173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor