Provider Demographics
NPI:1609641877
Name:LONG, KENNETH C (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:LONG
Suffix:
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-1428
Mailing Address - Country:US
Mailing Address - Phone:509-946-1430
Mailing Address - Fax:509-946-1432
Practice Address - Street 1:1124 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3360
Practice Address - Country:US
Practice Address - Phone:509-946-1430
Practice Address - Fax:509-946-1430
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral