MEDICARE: TAMMY YVONNE LONG MA, NCC

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	101YM0800X	Mental Health Counselor	IMH 7039	FL
2	106H00000X	Marriage & Family Therapist	IMT 1205	FL

General Provider Information

NPI Number	:	1376795708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY YVONNE LONG MA, NCC

Provider Business Mailing Address
First Line	:	4252 PLAYER CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2212
Country	:	US
Telephone Number	:	407-470-0864
Fax Number	:	407-291-1028

Provider Business Practice Location Address
First Line	:	4252 PLAYER CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2212
Country	:	US
Telephone Number	:	407-470-0864
Fax Number	:	407-291-1028

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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