Richard Long
Individual provider Active NPI Mental Health Counselor · Kwethluk, AK
NPI 1124240304 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1124240304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- First Street Old Clinic Building
Kwethluk, AK 99559 - Phone
- (907) 543-6100
- Fax
- (907) 543-6008
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
First Street Old Clinic Building
Kwethluk, AK 99559
Mailing address
PO Box 528
Bethel, AK 99559-0528
Phone (907) 543-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA4442 | Medicaid | AK |
Other providers in Kwethluk, AK
- Katrina Crane
- Patricia M.M. David
- Willie Nick David
- Jordan T Fisher
- Rhonda M Jackson
- Charlamagne C Olick
- Alexandra Peterson
- Carla Suskuk
All providers in Kwethluk, AK · Mental Health Counselor in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.