Provider Demographics
NPI:1275808883
Name:LONG, KRISTEN L (LPC, CACII)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC, CACII
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:SOLIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 ACOMA BLVD N STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6096
Mailing Address - Country:US
Mailing Address - Phone:928-733-5101
Mailing Address - Fax:970-249-2955
Practice Address - Street 1:84 ACOMA BLVD N STE 104
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6096
Practice Address - Country:US
Practice Address - Phone:928-733-5101
Practice Address - Fax:970-249-2955
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health