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Theresa De Long

Marriage & Family Therapist

Behavioral Health & Social Service Providers

2730 Wilshire Blvd, Suite 660, Santa Monica, CA 90403

PECOS Enrollment

Based on the most recent information from CMS, provider Theresa De Long does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1447592555
Provider Type
Individual
Full Name
De Long, Theresa
Credential
MFT

Gender
Female
Sole Proprietor
No
Enumeration Date
3/27/2013
Last Updated
7/9/2018

Contact Information

Practice Location

2730 Wilshire Blvd, Suite 660, Santa Monica, CA 90403

(310) 383-0779

(310) 410-9507

Mailing Location

2730 Wilshire Blvd, Suite 660, Santa Monica, CA 90403

(310) 383-0779

(310) 410-9507

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID MFC 52307	Description Other	Issuer LICENSE California

Theresa De Long

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Goldberg, Bill E

Poper, Jacquelyn

Ross, Ellie

Pickett, Karen

Kadkhoda, Monica Farassat

Blue, Caitlin

Tappan, Alexandra

Kati Morton, Lmft

Durrschmidt, Eric

Wooden, Tessa