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General NPI Number Information
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NPI Number | 1942600606
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Entity Type | Organization
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Legal Business Name | TIMOTHY D LONG, LMFT
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Dates
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Enumeration Date | 09/01/2014
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Last Update Date | 09/01/2014
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Provider Practice Location Address
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Address Line | 329 N WETHERLY DR SUITE 206
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1605
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Country | US
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Telephone | 310-203-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 329 N WETHERLY DR SUITE 206
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1605
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Country | US
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Telephone | 310-203-1510
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. TIMOTHY D LONG
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Credential | LMFT, LPCC
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Telephone | 310-203-1510
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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 | LPCC1152
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47459
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License Number State | CA
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