Individual
MS. KELSEY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8873 QUIMPER PL, SHREVEPORT, LA 71105-5620
(318) 686-0012
Mailing address
8873 QUIMPER PL, SHREVEPORT, LA 71105-5620
(318) 686-0012
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5308
LA
Other
Enumeration date
07/12/2019
Last updated
07/12/2019
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