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General NPI Number Information
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NPI Number | 1720564933
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Entity Type | Organization
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Legal Business Name | DAWN LEA LONG COUNSELING LLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 5350 S WESTERN AVE STE 211
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-4525
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Country | US
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Telephone | 405-863-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 5350 S WESTERN AVE STE 211
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-4525
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Country | US
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Telephone | 405-863-2602
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR/ COUNSELOR
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Name | MS. DAWN LEA LONG
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Credential | MHR LADC LBHP
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Telephone | 405-863-2602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1213
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License Number State | OK
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