Provider Demographics
NPI:1417147372
Name:BEVERLY LONG, PSY.D., L.P., LLC
Entity Type:Organization
Organization Name:BEVERLY LONG, PSY.D., L.P., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-253-8438
Mailing Address - Street 1:546 WINONA ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2425
Mailing Address - Country:US
Mailing Address - Phone:651-253-8438
Mailing Address - Fax:
Practice Address - Street 1:546 WINONA ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2425
Practice Address - Country:US
Practice Address - Phone:651-253-8438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1680251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health