Individual
BRIAN J LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1850 GATES AVE, KINGMAN, AZ 86401-8003
(928) 377-0453
Mailing address
4085 N VAN NUYS RD, KINGMAN, AZ 86409-2544
(928) 377-0453
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
22972
AZ
Other
Enumeration date
12/07/2022
Last updated
12/07/2022
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