Robert Wayne Long, CDP

Primary specialty

SpecialistTaxonomy code 174400000X

License

CP00002606 Issued in WA

Practice address

10215 214TH Ave E
Bonney Lake, WA 98391-3909

Phone

(253) 862-7374

Fax

(253) 862-0448

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freedom Recovery Center LLC

  • Addiction (Substance Use Disorder) Counselor
  • Bonney Lake, WA
  • NPI 1487884441
  NPD (past) Authorized official
• New Freedom Recovery Center LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bonney Lake, WA
  • NPI 1215352018
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1508908880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10215 214TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983913909",
            "telephone_number": "253-862-7374",
            "fax_number": "253-862-0448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 214TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983913909",
            "telephone_number": "253-862-7374",
            "fax_number": "253-862-0448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "CP00002606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linden Hale Nutrition LLC
• Rylie Linford
• Carrie Lister Webb, LMP
• Karla Danao Little
• Benjamin Lochala, PHARMD, RPH
• Honey Laraine Lopez, PTA
• Loyal Kingdom LLC
• Loyal Kingdom LLC
• Stephanie Lyman, ARNP
• Andrea Marie Lynde, DO

• Specialist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.