Provider Demographics
NPI:1083752679
Name:COLSON-YOUNG, LAURIE (MA)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:COLSON-YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:L
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:389 DOWNING LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2035
Mailing Address - Country:US
Mailing Address - Phone:805-268-4425
Mailing Address - Fax:805-937-6316
Practice Address - Street 1:136 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7002
Practice Address - Country:US
Practice Address - Phone:805-735-7068
Practice Address - Fax:805-736-1253
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist