Provider Demographics
NPI:1720802499
Name:LONG, GABRIELLE MARIE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MARIE
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 1:1626 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4510
Mailing Address - Country:US
Mailing Address - Phone:713-922-6717
Mailing Address - Fax:
Practice Address - Street 1:2743 SMITH RANCH RD UNIT 1202
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5219
Practice Address - Country:US
Practice Address - Phone:832-598-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician