Provider Demographics
NPI:1285031880
Name:YOUNG, BREANNA DANAE (LMHC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:DANAE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-8350
Mailing Address - Fax:515-643-5824
Practice Address - Street 1:1111 6TH AVE # W3
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-643-8350
Practice Address - Fax:515-643-5824
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health