Provider Demographics
NPI:1518135128
Name:ASHFORD, SIMMONS, & YOUNG PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:ASHFORD, SIMMONS, & YOUNG PSYCHOLOGICAL SERVICES
Other - Org Name:ASY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPEHR
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED
Authorized Official - Phone:803-254-1210
Mailing Address - Street 1:1825 SAINT JULIAN PL
Mailing Address - Street 2:SUITE F1D-E
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2424
Mailing Address - Country:US
Mailing Address - Phone:803-254-1210
Mailing Address - Fax:803-254-4510
Practice Address - Street 1:1825 SAINT JULIAN PL
Practice Address - Street 2:SUITE F1D-E
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2424
Practice Address - Country:US
Practice Address - Phone:803-254-1210
Practice Address - Fax:803-254-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCGP3862101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3862Medicaid