Provider Demographics
NPI:1962861963
Name:YOUNG, LAUREN ELISE (MS, LPA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MANNA DR APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2615
Mailing Address - Country:US
Mailing Address - Phone:606-923-8789
Mailing Address - Fax:
Practice Address - Street 1:415 GIBSON LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2577
Practice Address - Country:US
Practice Address - Phone:859-623-9367
Practice Address - Fax:859-623-9389
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid