Provider Demographics
NPI:1376967596
Name:YOUNG-TURLEY, BONNIE HASTINGS (MED, LPCA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:HASTINGS
Last Name:YOUNG-TURLEY
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1963
Mailing Address - Country:US
Mailing Address - Phone:270-245-2205
Mailing Address - Fax:
Practice Address - Street 1:14 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1963
Practice Address - Country:US
Practice Address - Phone:270-245-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00216376101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30602015Medicaid