Provider Demographics
NPI:1376795708
Name:LONG, TAMMY YVONNE (MA, NCC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:YVONNE
Last Name:LONG
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 PLAYER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2212
Mailing Address - Country:US
Mailing Address - Phone:407-470-0864
Mailing Address - Fax:407-291-1028
Practice Address - Street 1:4252 PLAYER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2212
Practice Address - Country:US
Practice Address - Phone:407-470-0864
Practice Address - Fax:407-291-1028
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 7039101YM0800X
FLIMT 1205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist