Most Relevant Information
Provider Data
| NPI Number: | 1003217456 |
| Provider Name: | THERESE LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/04/2014 |
| Last Updated: | 01/25/2024 |
Provider Practice Location
4300 NE FREMONT ST STE 260
PORTLAND
OR
972131100
Practice Location Phone/Fax
| Phone: | 5035449996 |
| Fax: |
Provider Mailing Location
14600 NW CORNELL RD
PORTLAND
OR
972295442
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |