Provider Demographics
NPI:1912967449
Name:LONG, GAIL DIANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DIANE
Last Name:LONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:SUITE #503
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-343-3321
Mailing Address - Fax:509-343-3323
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE #503
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-343-3321
Practice Address - Fax:509-343-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health