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NPI Code Detail

MEDICARE: WALTER R LONG L.P.C.

MEDICARE: WALTER R LONG L.P.C.
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
1101YP2500XProfessional CounselorLPC-13843AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801120951
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER R LONG L.P.C.
Provider Business Mailing Address
First Line : 2434 E BLANCHE DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-4313
Country : US
Telephone Number : 602-456-0340
Fax Number : 480-571-5367
Provider Business Practice Location Address
First Line : 2434 E BLANCHE DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-4313
Country : US
Telephone Number : 602-456-0340
Fax Number : 480-571-5367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2009
Last Update Date : 07/26/2021

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Directions to “ WALTER R LONG L.P.C.” Practice Location

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