Provider Demographics
NPI:1255851283
Name:YOUR LONG RUN LLC
Entity Type:Organization
Organization Name:YOUR LONG RUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-525-8113
Mailing Address - Street 1:2742 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2124
Mailing Address - Country:US
Mailing Address - Phone:540-525-8113
Mailing Address - Fax:
Practice Address - Street 1:2742 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-2124
Practice Address - Country:US
Practice Address - Phone:540-525-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty