Provider Demographics
NPI:1922342609
Name:YOUNG, LIDIA (LSCSW)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 W. 151ST ST.
Mailing Address - Street 2:#109
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2231
Mailing Address - Country:US
Mailing Address - Phone:913-681-6068
Mailing Address - Fax:
Practice Address - Street 1:7111 W. 151ST ST.
Practice Address - Street 2:#109
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2231
Practice Address - Country:US
Practice Address - Phone:913-681-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical