Individual
MRS. AMANDA JO LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27753 S WELLING RD, WELLING, OK 74471-2202
(918) 457-4999
Mailing address
PO BOX 734, STILWELL, OK 74960-0734
(918) 696-7453
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/28/2014
Last updated
01/28/2014
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