Provider Demographics
NPI:1366871642
Name:LONG, MATTHEW WALKER (MA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WALKER
Last Name:LONG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SHORES AVE
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-9046
Mailing Address - Country:US
Mailing Address - Phone:870-866-2786
Mailing Address - Fax:479-271-2219
Practice Address - Street 1:1002 SE C ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6327
Practice Address - Country:US
Practice Address - Phone:479-271-2120
Practice Address - Fax:479-271-2219
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)