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General NPI Number Information
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NPI Number | 1134834468
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Entity Type | Individual
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Provider Name | KRISTY LAUREN LONG AMFT
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Gender | Female
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2801 OCEAN PARK BLVD PNB 346
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City | SANTA MONICA
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State | CA
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Zip | 90405-2905
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Country | US
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Telephone | 424-229-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 621 S SPRING ST APT 209
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City | LOS ANGELES
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State | CA
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Zip | 90014-3917
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Country | US
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Telephone | 805-749-0014
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | AMFT132188
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License Number State | CA
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