Most Relevant Information
Provider Data
| NPI Number: | 1003354598 |
| Provider Name: | RICHARD LONG MSW, LCSW, M.DIV. |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 34000540A |
Most Important Dates
| Enumeration Date: | 02/06/2017 |
| Last Updated: | 02/06/2017 |
Provider Practice Location
6745 SPRING ST
PENDLETON
IN
460649026
Practice Location Phone/Fax
| Phone: | 7657780881 |
| Fax: |
Provider Mailing Location
6745 SPRING ST.
PENDLETON
IN
46064
Provider Mailing Phone/Fax
| Phone: | 7657780881 |
| Fax: |