Tiffanie Diane Long, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-8664 Issued in NU

Practice address

13932 Coyote Gulch
Pocatello, ID 83202-5195

Phone

(208) 410-0100

NPI assigned

Jul 18, 2019

Last updated

Jul 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brick House Recovery

  dba Renaissance Ranch

  • Substance Abuse Rehabilitation Facility
  • Meridian, ID
  • NPI 1083150296
  NPD (past)
• Brick House Recovery

  • Addiction (Substance Use Disorder) Counselor
  • Boise, ID
  • NPI 1770987844
  NPD (past)
• Just 4 Kids Health LLC

  dba Just 4 Kids Urgent Care

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1043722259
  NPD (past)
• Just 4 Kids Health LLC

  dba Just 4 Kids Mental Health

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1700651221
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1205489234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13932 COYOTE GULCH",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832025195",
            "telephone_number": "208-410-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13932 COYOTE GULCH",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832025195",
            "telephone_number": "208-410-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "TIFFANIE",
        "middle_name": "DIANE",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": "LCPC-8664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Livefree Emergency Response, Inc.
• Mathew Livermore, PT
• Kimberly Gail Lloyd, MOTR/L
• Madeline Amy Lloyd
• Becky Lobo
• Nicholas Longe, DO
• Julie Longmore Adams
• Lance Spencer Longmore, D.O.
• Ryan Bradley Longmore, D.O.
• Longshot Enterprises, Inc. (Home Helpers Home Health)

• Mental Health Counselor in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.