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NPI Code Detail

MEDICARE: JEFFRI LONG BCBA

MEDICARE:   JEFFRI  LONG  BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1205259181
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFRI LONG BCBA
Provider Business Mailing Address
First Line : 1501 W BEAUREGARD AVE
Second Line :
City : SAN ANGELO
State : TX
Zip : 76901-4004
Country : US
Telephone Number : 325-617-5845
Fax Number :
Provider Business Practice Location Address
First Line : 800 SPAULDING ST
Second Line :
City : SAN ANGELO
State : TX
Zip : 76903-4930
Country : US
Telephone Number : 325-617-5845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2014
Last Update Date : 01/28/2014

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Directions to “ JEFFRI LONG BCBA” Practice Location

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