Provider Demographics
NPI:1073248456
Name:PARK, SIN YOUNG (MS, CRC, LPC-IT)
Entity Type:Individual
Prefix:
First Name:SIN YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MS, CRC, LPC-IT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CRC, LPC-IT
Mailing Address - Street 1:725 UNIVERSITY ROW APT 307
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1453
Mailing Address - Country:US
Mailing Address - Phone:608-692-3532
Mailing Address - Fax:
Practice Address - Street 1:1717 N STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-2605
Practice Address - Country:US
Practice Address - Phone:608-838-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7064-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional