Provider Demographics
NPI:1811238033
Name:YOUNG, NAKETA LISETTE (MS)
Entity Type:Individual
Prefix:
First Name:NAKETA
Middle Name:LISETTE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8593 DOUBLETREE DR N
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9805
Mailing Address - Country:US
Mailing Address - Phone:219-201-1852
Mailing Address - Fax:
Practice Address - Street 1:7863 BROADWAY STE 220
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5547
Practice Address - Country:US
Practice Address - Phone:219-201-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional