Provider Demographics
NPI:1679709166
Name:LONG, ELIZABETH NIETO (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NIETO
Last Name:LONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:512 PAULDING CIR
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2857
Mailing Address - Country:US
Mailing Address - Phone:805-556-5532
Mailing Address - Fax:
Practice Address - Street 1:512 PAULDING CIR
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2857
Practice Address - Country:US
Practice Address - Phone:805-556-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist