Provider Demographics
NPI:1518116037
Name:YOUNG, LUTHER ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:LUTHER
Middle Name:ALEXANDER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2967
Mailing Address - Country:US
Mailing Address - Phone:417-882-4934
Mailing Address - Fax:417-725-6206
Practice Address - Street 1:380 E STATE HIGHWAY CC
Practice Address - Street 2:SUITE A105
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7337
Practice Address - Country:US
Practice Address - Phone:417-725-8810
Practice Address - Fax:417-725-6206
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health