Provider Demographics
NPI:1619535572
Name:YOUNG, LANCE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7028
Mailing Address - Country:US
Mailing Address - Phone:616-610-0329
Mailing Address - Fax:
Practice Address - Street 1:817 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7028
Practice Address - Country:US
Practice Address - Phone:616-610-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor