Provider Demographics
NPI:1447530563
Name:LONG, MARCIKUS DENISE
Entity type:Individual
Prefix:
First Name:MARCIKUS
Middle Name:DENISE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2743
Mailing Address - Country:US
Mailing Address - Phone:405-821-3005
Mailing Address - Fax:405-672-1170
Practice Address - Street 1:4109 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2743
Practice Address - Country:US
Practice Address - Phone:405-821-3005
Practice Address - Fax:405-672-1170
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst