Provider Demographics
NPI:1477312114
Name:YOUNGBLOOD, AMY L (MSW, SWLC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MSW, SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N LAST CHANCE GULCH STE 218
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5062
Mailing Address - Country:US
Mailing Address - Phone:406-461-1786
Mailing Address - Fax:
Practice Address - Street 1:314 N LAST CHANCE GULCH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5062
Practice Address - Country:US
Practice Address - Phone:406-461-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-31607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health