Provider Demographics
NPI:1396745329
Name:LONG, TONIA L (PHD)
Entity type:Individual
Prefix:DR
First Name:TONIA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1100 HALLE PARK CIRCLE
Mailing Address - Street 2:STE 101
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-651-2879
Mailing Address - Fax:901-562-0379
Practice Address - Street 1:1100 HALLE PARK CIRCLE
Practice Address - Street 2:STE 101
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-651-2879
Practice Address - Fax:901-562-0379
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001774103TA0700X, 103TC1900X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2047479OtherCIGNA
TN4004785OtherTN BLUE CROSS BLUE SHIELD
TN3980085Medicare PIN