Provider Demographics
NPI:1538826201
Name:LONGWORTH, TACOMA RAIN MENDELSOHN
Entity type:Individual
Prefix:MRS
First Name:TACOMA
Middle Name:RAIN MENDELSOHN
Last Name:LONGWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TACOMA
Other - Middle Name:RAIN
Other - Last Name:MENDELSOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2710
Mailing Address - Country:US
Mailing Address - Phone:406-259-1777
Mailing Address - Fax:
Practice Address - Street 1:554 PRONGHORN TRL STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6082
Practice Address - Country:US
Practice Address - Phone:406-624-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician