Provider Demographics
NPI:1497959555
Name:YOUNG, BETH ANN (PCC-S)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16503 SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9557
Mailing Address - Country:US
Mailing Address - Phone:937-537-6261
Mailing Address - Fax:
Practice Address - Street 1:16503 SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9557
Practice Address - Country:US
Practice Address - Phone:937-537-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0501151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional