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General NPI Number Information
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NPI Number | 1043596893
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH LONG PSYD, LCP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 11/17/2018
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Provider Practice Location Address
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Address Line | 1800 JACKSON ST STE 203
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City | GOLDEN
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State | CO
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Zip | 80401-2303
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Country | US
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Telephone | 720-594-3208
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Fax |
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Provider Business Mailing Address
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Address Line | 875 PONDEROSA DR
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City | EVERGREEN
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State | CO
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Zip | 80439-4803
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Country | US
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Telephone | 307-690-4179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1240
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0004897
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License Number State | CO
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