Provider Demographics
NPI:1326142449
Name:YOUNG, CYNTHIA ANN (MED LPC LCDC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED LPC LCDC
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:PEARCE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED LPC LCDC
Mailing Address - Street 1:1219 E SOUTH 11TH
Mailing Address - Street 2:STE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602
Mailing Address - Country:US
Mailing Address - Phone:325-676-2039
Mailing Address - Fax:325-670-9793
Practice Address - Street 1:1219 E SOUTH 11TH
Practice Address - Street 2:STE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602
Practice Address - Country:US
Practice Address - Phone:325-676-2039
Practice Address - Fax:325-670-9793
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4629101YA0400X
TX11651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028508201Medicaid
TX2328LCOtherBCBS