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General NPI Number Information
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NPI Number | 1902228232
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Entity Type | Individual
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Provider Name | CHRISTY LONG LCSW, SUDC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 2995 N COLE RD STE 225
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City | BOISE
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State | ID
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Zip | 83704-5966
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Country | US
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Telephone | 208-258-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 S 30 E
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City | PAYSON
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State | UT
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Zip | 84651-3021
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Country | US
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Telephone | 208-258-5460
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Fax | 417-794-1186
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9045497-3501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2061976
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License Number State | ID
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