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General NPI Number Information
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NPI Number | 1043689219
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Entity Type | Individual
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Provider Name | AMY LONG PSY.D, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 05/27/2023
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Provider Practice Location Address
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Address Line | 3585 VAN TEYLINGEN DR STE C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-4872
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Country | US
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Telephone | 719-629-8574
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Fax | 719-213-2839
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Provider Business Mailing Address
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Address Line | 2906 BEACON ST STE B
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6193
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Country | US
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Telephone | 719-629-8574
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Fax | 719-213-2839
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0005029
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0012243
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License Number State | CO
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