Individual
MR. SHANE RAYMOND LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.F.T.
Contact information
Practice address
516 MISSION HOUSE LN, NEW BRIGHTON, MN 55112-2571
(651) 636-5120
(651) 636-5124
Mailing address
516 MISSION HOUSE LN, NEW BRIGHTON, MN 55112-2571
(651) 636-5120
(651) 636-5124
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2462
MN
Other
Enumeration date
01/24/2012
Last updated
01/24/2012
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