Provider Demographics
NPI:1861608333
Name:LONG, SUSAN JOY (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOY
Last Name:LONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-2849
Mailing Address - Country:US
Mailing Address - Phone:503-812-6788
Mailing Address - Fax:
Practice Address - Street 1:309 ELM AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3437
Practice Address - Country:US
Practice Address - Phone:503-812-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist