Individual
MICHAEL PAUL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
14523 WESTLAKE DRIVE, LAKE OSWEGO, OR 97035, LAKE OSWEGO, OR 97035
(971) 280-0370
Mailing address
14523 WESTLAKE DRIVE, LAKE OSWEGO, OR 97035, LAKE OSWEGO, OR 97035
(971) 280-0370
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L6758
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L6758
LICENSED CLINICAL SOCIAL WORKER
OR
Enumeration date
09/27/2017
Last updated
07/21/2022
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