Provider Demographics
NPI:1831400969
Name:LONG, TERESA ANN (BA/CADC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:BA/CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NORTHERN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3893
Mailing Address - Country:US
Mailing Address - Phone:405-210-2098
Mailing Address - Fax:
Practice Address - Street 1:1401 NORTHERN HILLS RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3893
Practice Address - Country:US
Practice Address - Phone:405-210-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)