Provider Demographics
NPI:1659808319
Name:LONG, WHITNEY MICHELLE
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-1610
Mailing Address - Country:US
Mailing Address - Phone:580-334-4306
Mailing Address - Fax:405-251-8241
Practice Address - Street 1:505 CHEROKEE HLS
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-5239
Practice Address - Country:US
Practice Address - Phone:580-334-4306
Practice Address - Fax:405-251-8241
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical