Provider Demographics
NPI:1568078285
Name:LONGPRE, WILLIAM G
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:LONGPRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 S CLEARWATER LOOP STE B
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5437
Mailing Address - Country:US
Mailing Address - Phone:208-777-2169
Mailing Address - Fax:208-625-2076
Practice Address - Street 1:570 S CLEARWATER LOOP STE B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5437
Practice Address - Country:US
Practice Address - Phone:208-777-2169
Practice Address - Fax:208-777-2189
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8927101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor