Provider Demographics
NPI:1699861385
Name:LONGAN, BARBARA JO (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JO
Last Name:LONGAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-439-2717
Mailing Address - Fax:417-627-9968
Practice Address - Street 1:2431 S RANGELINE RD
Practice Address - Street 2:STE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-439-8717
Practice Address - Fax:417-627-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991353921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495251910Medicaid
MO495251910Medicaid