Provider Demographics
NPI:1336465087
Name:MARZETT-LONG, LA DONNA (BHRS)
Entity Type:Individual
Prefix:
First Name:LA DONNA
Middle Name:
Last Name:MARZETT-LONG
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3600
Mailing Address - Country:US
Mailing Address - Phone:405-455-7022
Mailing Address - Fax:
Practice Address - Street 1:7901 N. E. 10TH
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3525
Practice Address - Country:US
Practice Address - Phone:405-455-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst