Provider Demographics
NPI:1114087251
Name:YOUNG, KEITH (LCPC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 UNION ST STE C
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6116
Mailing Address - Country:US
Mailing Address - Phone:207-951-7811
Mailing Address - Fax:888-972-1920
Practice Address - Street 1:175 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6116
Practice Address - Country:US
Practice Address - Phone:207-951-7811
Practice Address - Fax:888-972-1920
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME286460099Medicaid
ME100029OtherANTHEM