Provider Demographics
NPI:1528354479
Name:LONG, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BROADWAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5801
Mailing Address - Country:US
Mailing Address - Phone:580-332-3001
Mailing Address - Fax:
Practice Address - Street 1:124 S. BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5825
Practice Address - Country:US
Practice Address - Phone:580-332-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health