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General NPI Number Information
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NPI Number | 1205201894
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Entity Type | Individual
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Provider Name | TODD ANDREW LONG
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Gender | Male
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 301 S J T STITES ST
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City | SALLISAW
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State | OK
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Zip | 74955-9302
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Country | US
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Telephone | 918-774-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S J T STITES ST
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City | SALLISAW
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State | OK
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Zip | 74955-9302
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Country | US
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Telephone | 918-774-1413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11484
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License Number State | OK
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