Healthcare Provider Details

I. General information

NPI: 1336552520
Provider Name (Legal Business Name): SANSANEE LONGBRAKE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S WASHINGTON ST
TIFFIN OH
44883-3325
US

IV. Provider business mailing address

1305 PELTON RD
FOSTORIA OH
44830-9760
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-4094
  • Fax:
Mailing address:
  • Phone: 419-420-5012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1300189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: