Provider Demographics
NPI:1770307134
Name:LONG, LAUREN KEELEY
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KEELEY
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 STALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1473
Mailing Address - Country:US
Mailing Address - Phone:678-633-2938
Mailing Address - Fax:
Practice Address - Street 1:7500 SAN FELIPE ST STE 990
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1708
Practice Address - Country:US
Practice Address - Phone:470-394-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician