Individual
WALTER R LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
2434 E BLANCHE DR, PHOENIX, AZ 85032-4313
(602) 456-0340
(480) 571-5367
Mailing address
2434 E BLANCHE DR, PHOENIX, AZ 85032-4313
(602) 456-0340
(480) 571-5367
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-13843
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
851520
—
AZ
Enumeration date
09/22/2009
Last updated
07/26/2021
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