Provider Demographics
NPI:1194913905
Name:LONG, WESLEY CORNELL (PHD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:CORNELL
Last Name:LONG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4805 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2058
Mailing Address - Country:US
Mailing Address - Phone:405-767-1126
Mailing Address - Fax:405-767-6285
Practice Address - Street 1:4805 RICHMOND SQ
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2058
Practice Address - Country:US
Practice Address - Phone:405-767-1126
Practice Address - Fax:405-767-6285
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health