Provider Demographics
NPI:1366839011
Name:LONG, PATRICIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WALL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7800
Mailing Address - Country:US
Mailing Address - Phone:530-828-1876
Mailing Address - Fax:
Practice Address - Street 1:315 WALL ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7800
Practice Address - Country:US
Practice Address - Phone:530-828-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist