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NPI Code Detail

MEDICARE: SHAWN LONG

MEDICARE: SHAWN LONG
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.174773OH

General Provider Information

NPI Number : 1619570173
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN LONG
Provider Business Mailing Address
First Line : 618 HOLCOMB ST APT 7
Second Line :
City : GRAYSON
State : KY
Zip : 41143-1258
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1724 S 3RD ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-2269
Country : US
Telephone Number : 740-479-5135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2020
Last Update Date : 01/18/2026

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Directions to “ SHAWN LONG ” Practice Location

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