Provider Demographics
NPI:1720860422
Name:DELONG, MATTHEW (PLPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DELONG
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST SE
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2731
Mailing Address - Country:US
Mailing Address - Phone:406-872-0630
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2731
Practice Address - Country:US
Practice Address - Phone:406-782-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health