Healthcare Provider Details

I. General information

NPI: 1134834468
Provider Name (Legal Business Name): KRISTY LAUREN LONG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD PMB 109372
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

621 S SPRING ST APT 209
LOS ANGELES CA
90014-3917
US

V. Phone/Fax

Practice location:
  • Phone: 805-749-0016
  • Fax: 747-227-0926
Mailing address:
  • Phone: 805-749-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT163942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: