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Individual

GREGORY A LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSW, LCSW

Contact information

Practice address
604 E 25TH ST, CHEYENNE, WY 82001-3133
(307) 637-3953
(307) 638-6805
Mailing address
604 E 25TH ST, CHEYENNE, WY 82001-3133
(307) 637-3953
(307) 638-6805

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
172
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
306812
BS
WY
01
MH100
WINHEALTH
WY
Enumeration date
12/09/2005
Last updated
03/25/2011
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