Provider Demographics
NPI:1578900411
Name:YOUNGREN, AMANDA KATHERINE (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:YOUNGREN
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KATHERINE
Other - Last Name:GLOUDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-0591
Mailing Address - Country:US
Mailing Address - Phone:952-247-1316
Mailing Address - Fax:
Practice Address - Street 1:1428 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4402
Practice Address - Country:US
Practice Address - Phone:952-247-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC01110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health