Provider Demographics
NPI:1295514255
Name:LONGORIA, MIRIAM N/A (BSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:N/A
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:N/A
Other - Last Name:LONGORIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW
Mailing Address - Street 1:1739 W CARTMELL ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4032
Mailing Address - Country:US
Mailing Address - Phone:509-361-4040
Mailing Address - Fax:
Practice Address - Street 1:LUTHERAN COMMUNITY SERVICES NW
Practice Address - Street 2:3321 W KENNEWICK AVE SUITE 150
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-735-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor