Active NPI
Brian J Long, BA
- Pastoral Counselor
- Kingman, AZ
National Provider Identifier
1508577800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 22972
- Practice address
- 1850 Gates Ave
Kingman, AZ 86401-8003 - Phone
- (928) 377-0453
- NPI assigned
- Dec 7, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 22972 | AZ | Primary |
Addresses
Primary practice location
1850 Gates Ave
Kingman, AZ 86401-8003
Mailing address
4085 N Van Nuys Rd
Kingman, AZ 86409-2544
Phone (928) 377-0453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22972 | AZ | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670371200000",
"number": "1508577800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4085 N VAN NUYS RD",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864092544",
"telephone_number": "928-377-0453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 GATES AVE",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864018003",
"telephone_number": "928-377-0453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "BRIAN",
"middle_name": "J",
"credential": "BA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-07",
"last_updated": "2022-12-07",
"certification_date": "2022-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "AZ",
"license": "22972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.