Provider Demographics
NPI:1013520402
Name:LONG, SAVANNAH SUE (CT)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:SUE
Last Name:LONG
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 1/2 E PERRY ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2248
Mailing Address - Country:US
Mailing Address - Phone:419-603-1317
Mailing Address - Fax:
Practice Address - Street 1:1640 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6849
Practice Address - Country:US
Practice Address - Phone:419-419-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902166-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor