Healthcare Provider Details

I. General information

NPI: 1669818209
Provider Name (Legal Business Name): JOHNSON-LONG CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 2ND ST STE 44
SANTA FE NM
87505-3499
US

IV. Provider business mailing address

PO BOX 29001
SANTA FE NM
87592-9001
US

V. Phone/Fax

Practice location:
  • Phone: 505-360-5222
  • Fax: 866-539-7654
Mailing address:
  • Phone: 505-360-5222
  • Fax: 866-539-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LOUISE A. LONG
Title or Position: SOLE MEMBER
Credential: LMFT, LADAC
Phone: 505-360-5222