Provider Demographics
NPI:1841436623
Name:LONG, PHYLLIS CATHERINE VOKEY (MFT)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:CATHERINE VOKEY
Last Name:LONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 LAKE PARK WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1674
Mailing Address - Country:US
Mailing Address - Phone:619-920-1240
Mailing Address - Fax:
Practice Address - Street 1:5575 LAKE PARK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1664
Practice Address - Country:US
Practice Address - Phone:619-920-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist