Provider Demographics
NPI:1598408825
Name:LONG, HAIDYN MACKENZIE (MA CMHC)
Entity Type:Individual
Prefix:
First Name:HAIDYN
Middle Name:MACKENZIE
Last Name:LONG
Suffix:
Gender:F
Credentials:MA CMHC
Other - Prefix:
Other - First Name:HAIDYN
Other - Middle Name:MACKENZIE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CMHC
Mailing Address - Street 1:777 N CRUSEY ST STE B109
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7101
Mailing Address - Country:US
Mailing Address - Phone:907-745-6200
Mailing Address - Fax:
Practice Address - Street 1:7335 E PALMER WASILLA HWY STE 2B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7710
Practice Address - Country:US
Practice Address - Phone:912-674-0417
Practice Address - Fax:907-745-6200
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health