Provider Demographics
NPI:1801144498
Name:LONG, BRADLEY DEAN (RASI)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DEAN
Last Name:LONG
Suffix:
Gender:M
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LANDING CIRCLE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-898-8326
Mailing Address - Fax:530-898-0239
Practice Address - Street 1:40 LANDING CIRCLE
Practice Address - Street 2:SUITE #1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-898-8326
Practice Address - Fax:530-898-0239
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-L1108311119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)