Provider Demographics
NPI:1043689219
Name:LONG, AMY (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 BEACON ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6193
Mailing Address - Country:US
Mailing Address - Phone:719-629-8574
Mailing Address - Fax:719-213-2839
Practice Address - Street 1:3585 VAN TEYLINGEN DR STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4872
Practice Address - Country:US
Practice Address - Phone:719-629-8574
Practice Address - Fax:719-213-2839
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005029103T00000X
COLPC.0012243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional