Provider Demographics
NPI:1275917338
Name:LONGAKER, CHAD (MED LMHC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LONGAKER
Suffix:
Gender:M
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S PERRY PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-4209
Mailing Address - Country:US
Mailing Address - Phone:509-987-4229
Mailing Address - Fax:509-357-8175
Practice Address - Street 1:1409 N PITTSBURG ST STE C
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8213
Practice Address - Country:US
Practice Address - Phone:509-581-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60505492101YM0800X
WA60645976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066794Medicaid