Provider Demographics
NPI:1184292476
Name:LONG, KAREN JEAN (MFT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JEAN
Last Name:LONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JEAN
Other - Last Name:LINDAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:24877 SKYLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-8161
Mailing Address - Country:US
Mailing Address - Phone:408-353-1807
Mailing Address - Fax:
Practice Address - Street 1:24877 SKYLAND RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95033-8161
Practice Address - Country:US
Practice Address - Phone:408-353-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist