Provider Demographics
NPI:1346639804
Name:YOUNG, ABBY (LSCSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1561
Mailing Address - Country:US
Mailing Address - Phone:785-393-2541
Mailing Address - Fax:
Practice Address - Street 1:512 E 9TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2679
Practice Address - Country:US
Practice Address - Phone:785-393-2541
Practice Address - Fax:785-393-2541
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201107170AMedicaid