Provider Demographics
NPI:1225807886
Name:S ANN LONG TRAUMA THERAPIST COLLECTIVE PLC
Entity Type:Organization
Organization Name:S ANN LONG TRAUMA THERAPIST COLLECTIVE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-321-4564
Mailing Address - Street 1:12 GREEN MOUNTAIN DR APT 7
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3814
Mailing Address - Country:US
Mailing Address - Phone:319-321-4564
Mailing Address - Fax:
Practice Address - Street 1:12 GREEN MOUNTAIN DR APT 7
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3814
Practice Address - Country:US
Practice Address - Phone:319-321-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty