Individual
JESSICA LYNN LONG
Active
Individual
JESSICA LYNN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PY60253462
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GH57134
—
RI
Enumeration date
10/02/2008
Last updated
03/29/2022
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