Provider Demographics
NPI:1457880809
Name:LONG, JAYCE (PHD)
Entity type:Individual
Prefix:
First Name:JAYCE
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16162 BEACH BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3894
Mailing Address - Country:US
Mailing Address - Phone:562-548-1398
Mailing Address - Fax:310-395-0863
Practice Address - Street 1:16162 BEACH BLVD STE 308
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3894
Practice Address - Country:US
Practice Address - Phone:562-548-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical