Provider Demographics
NPI:1689963928
Name:YOUNG, BEVERLY R (LMHC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMHC
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 6181
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-6181
Mailing Address - Country:US
Mailing Address - Phone:765-854-6010
Mailing Address - Fax:765-854-6011
Practice Address - Street 1:1216 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4341
Practice Address - Country:US
Practice Address - Phone:765-854-6010
Practice Address - Fax:765-854-6011
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002256A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health