Provider Demographics
NPI:1962821454
Name:YOUNG, GINA R (LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:YOUNG
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 1:505 S DEWEY ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3704
Mailing Address - Country:US
Mailing Address - Phone:715-832-5951
Mailing Address - Fax:715-832-6680
Practice Address - Street 1:505 S DEWEY ST
Practice Address - Street 2:SUITE 208
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3704
Practice Address - Country:US
Practice Address - Phone:715-832-5951
Practice Address - Fax:715-832-6680
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILPC 5183-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional