Provider Demographics
NPI:1942751045
Name:YOUNGER, MARY C (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 S CEDAR CREST CT STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6993
Mailing Address - Country:US
Mailing Address - Phone:816-777-9132
Mailing Address - Fax:
Practice Address - Street 1:4710 S CEDAR CREST CT STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-777-9132
Practice Address - Fax:816-623-0200
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015014878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional