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Individual

DR. LORI LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D., NCSP

Contact information

Practice address
7600 N 16TH ST, SUITE 218, PHOENIX, AZ 85020-4431
(602) 904-3405
Mailing address
7600 N 16TH ST, SUITE 218, PHOENIX, AZ 85020-4431
(602) 904-3405

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
4207
AZ
103TM1800X
Intellectual & Developmental Disabilities Psychologist
4207
AZ
103TS0200X
School Psychologist
Primary
4207
AZ

Other

Enumeration date
09/22/2011
Last updated
09/27/2011
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