MEDICARE: BRITTANY LONG III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3697678	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144483827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY LONG III

Provider Business Mailing Address
First Line	:	900 E HILL AVENUE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	39715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E HILL AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2566
Country	:	US
Telephone Number	:	865-633-9844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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Directions to “ BRITTANY LONG III ” Practice Location

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