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General NPI Number Information
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NPI Number | 1205333283
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Entity Type | Individual
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Provider Name | CLARA ELIZABETH LONG PHD, LPC, BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1320 CARMICHAEL WAY
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City | MONTGOMERY
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State | AL
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Zip | 36106-3691
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Country | US
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Telephone | 334-356-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 CARMICHAEL WAY
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City | MONTGOMERY
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State | AL
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Zip | 36106-3691
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Country | US
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Telephone | 256-710-6011
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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 | 3854
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2019-033
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License Number State | AL
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