Provider Demographics
NPI:1497027163
Name:LONG, JOHN F
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:628 W BROADWAY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5544
Mailing Address - Country:US
Mailing Address - Phone:501-372-4242
Mailing Address - Fax:
Practice Address - Street 1:628 W BROADWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5544
Practice Address - Country:US
Practice Address - Phone:501-372-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0111L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)