Provider Demographics
NPI:1417184516
Name:LONG, MERRY (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MERRY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18537 1ST AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148
Mailing Address - Country:US
Mailing Address - Phone:206-241-0972
Mailing Address - Fax:
Practice Address - Street 1:18537 1ST AVE S STE C
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-1888
Practice Address - Country:US
Practice Address - Phone:206-241-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60059060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist