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NPI Code Detail

MEDICARE: ASHLEY LONG

MEDICARE: ASHLEY LONG
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1588333124
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY LONG
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 1355 GARDEN OF THE GODS RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3431
Country : US
Telephone Number : 719-476-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2021
Last Update Date : 02/19/2024

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Directions to “ ASHLEY LONG ” Practice Location

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