Healthcare Provider Details

I. General information

NPI: 1245454750
Provider Name (Legal Business Name): CECILY LONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 03/17/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W MICHELTORENA ST STE B
SANTA BARBARA CA
93101-6525
US

IV. Provider business mailing address

PO BOX 91321
SANTA BARBARA CA
93190-1321
US

V. Phone/Fax

Practice location:
  • Phone: 805-729-3338
  • Fax: 805-733-1213
Mailing address:
  • Phone: 805-729-3338
  • Fax: 805-733-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT86591
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: