Provider Demographics
NPI:1922783091
Name:LONG, STEPHEN DAVID
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DAVID
Last Name:LONG
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 1:6026 37TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7406
Mailing Address - Country:US
Mailing Address - Phone:206-963-9497
Mailing Address - Fax:
Practice Address - Street 1:20006 CEDAR VALLEY RD STE 113
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6478
Practice Address - Country:US
Practice Address - Phone:206-963-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty