MEDICARE: DR. AMY LONG PSY.D, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY.0005029	CO
2	101YP2500X	Professional Counselor	LPC.0012243	CO

General Provider Information

NPI Number	:	1043689219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LONG PSY.D, LPC

Provider Business Mailing Address
First Line	:	2906 BEACON ST STE B
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6193
Country	:	US
Telephone Number	:	719-629-8574
Fax Number	:	719-213-2839

Provider Business Practice Location Address
First Line	:	3585 VAN TEYLINGEN DR STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4872
Country	:	US
Telephone Number	:	719-629-8574
Fax Number	:	719-213-2839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	05/27/2023

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