Provider Demographics
NPI:1730491762
Name:YOUNG, KRISTINA LEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 51ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2537
Mailing Address - Country:US
Mailing Address - Phone:316-838-1238
Mailing Address - Fax:316-838-1140
Practice Address - Street 1:1701 W 51ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-2537
Practice Address - Country:US
Practice Address - Phone:316-838-1238
Practice Address - Fax:316-838-1140
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker