Individual
MRS. ROBERTA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
570 EAST 3RD, HALLETT, OK 74034
(918) 845-8921
Mailing address
PO BOX 76, HALLETT, OK 74034
(918) 845-8921
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/24/2014
Last updated
04/24/2014
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