Provider Demographics
NPI:1407414600
Name:LONG, KRISTIN KATHLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KATHLEEN
Last Name:LONG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHOCTAW WAY
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571
Mailing Address - Country:US
Mailing Address - Phone:918-567-3065
Mailing Address - Fax:918-567-3917
Practice Address - Street 1:ONE CHOCTAW WAY
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571
Practice Address - Country:US
Practice Address - Phone:918-567-3065
Practice Address - Fax:918-567-3917
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker