Individual
BENJAMIN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 E 1ST ST, WACONIA, MN 55387
(952) 442-4437
(952) 442-3084
Mailing address
540 E 1ST ST, WACONIA, MN 55387-1600
(952) 442-4437
(952) 442-3084
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC01004
MN
Other
Enumeration date
06/08/2015
Last updated
08/16/2018
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