Most Relevant Information
Provider Data
| NPI Number: | 1003674169 |
| Provider Name: | REYAN LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/12/2024 |
| Last Updated: | 03/12/2024 |
Provider Practice Location
4234 CASCADE RD SE STE 3
GRAND RAPIDS
MI
495468384
Practice Location Phone/Fax
| Phone: | 8776544144 |
| Fax: |
Provider Mailing Location
4234 CASCADE RD SE STE 3
GRAND RAPIDS
MI
495468384
Provider Mailing Phone/Fax
| Phone: | 8776544144 |
| Fax: |