Organization
BEVERLY JEAN LONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET MARIE MEULEMANS (ADMINISTRATIVE ASSISTANT/BILLER)
(651) 307-7865
Entity
Organization
Contact information
Practice address
1595 SELBY AVE, SUITE 202, SAINT PAUL, MN 55104-6221
(651) 253-8438
Mailing address
546 WINONA ST E, SAINT PAUL, MN 55107-2425
(651) 253-8438
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1680
MN
Other
Enumeration date
11/18/2008
Last updated
11/18/2008
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