Provider Demographics
NPI:1760160188
Name:YOUNG, JENNIFER NOELLE (LLC, ATR-P)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NOELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LLC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-8843
Mailing Address - Country:US
Mailing Address - Phone:269-303-0815
Mailing Address - Fax:
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23-002221700000X
MI6451055887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist