Provider Demographics
NPI:1922884048
Name:LONG, TAYLOR JAMES
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JAMES
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 1:7938 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8636
Mailing Address - Country:US
Mailing Address - Phone:218-270-2981
Mailing Address - Fax:218-270-2921
Practice Address - Street 1:7938 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8636
Practice Address - Country:US
Practice Address - Phone:218-270-2981
Practice Address - Fax:218-270-2921
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician