Provider Demographics
NPI:1639996804
Name:BRAD DELONG THERAPY, PLLC
Entity type:Organization
Organization Name:BRAD DELONG THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-799-6011
Mailing Address - Street 1:5424 UNITY AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3266
Mailing Address - Country:US
Mailing Address - Phone:612-799-6011
Mailing Address - Fax:
Practice Address - Street 1:4900 HIGHWAY 169 N STE 324
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4046
Practice Address - Country:US
Practice Address - Phone:612-234-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health