Individual
MRS. SHANEL ROSE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.S.A.C.
Contact information
Practice address
151 S UNIVERSITY AVE, PROVO, UT 84601-4427
(801) 851-7127
Mailing address
794 N LOAFER CANYON RD, ELK RIDGE, UT 84651-8572
(801) 885-7372
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6500376-6006
UT
Other
Enumeration date
11/22/2010
Last updated
11/22/2010
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