Individual
BRIAN THOMAS LONGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
120 SE 4TH ST, EVANSVILLE, IN 47708-1607
(812) 426-9862
(812) 426-9779
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20042512A
IN
103TC0700X
Clinical Psychologist
Primary
20042512A
IN
Other
Enumeration date
03/18/2021
Last updated
03/31/2021
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