Provider Demographics
NPI:1528566874
Name:YOUNG, KRYSTAL (LSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0132
Mailing Address - Country:US
Mailing Address - Phone:740-594-6807
Mailing Address - Fax:740-594-9967
Practice Address - Street 1:11 GRAHAM DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1430
Practice Address - Country:US
Practice Address - Phone:740-594-6807
Practice Address - Fax:740-594-9967
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1500525104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker