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General NPI Number Information
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NPI Number | 1609641877
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Entity Type | Individual
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Provider Name | KENNETH C LONG PASTORAL COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 1124 STEVENS DR
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City | RICHLAND
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State | WA
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Zip | 99354-3360
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Country | US
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Telephone | 509-946-1430
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Fax | 509-946-1430
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Provider Business Mailing Address
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Address Line | PO BOX 1428
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City | RICHLAND
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State | WA
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Zip | 99352-1428
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Country | US
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Telephone | 509-946-1430
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Fax | 509-946-1432
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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