Provider Demographics
NPI:1669818209
Name:JOHNSON-LONG CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:JOHNSON-LONG CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADAC
Authorized Official - Phone:505-360-5222
Mailing Address - Street 1:PO BOX 29001
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-9001
Mailing Address - Country:US
Mailing Address - Phone:505-360-5222
Mailing Address - Fax:866-539-7654
Practice Address - Street 1:1807 2ND ST STE 44
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3499
Practice Address - Country:US
Practice Address - Phone:505-360-5222
Practice Address - Fax:866-539-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health