Provider Demographics
NPI:1972634426
Name:DEHART-YOUNG, SARA (MS, LPC, ATR)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:DEHART-YOUNG
Suffix:
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TALLEY HO DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2747
Mailing Address - Country:US
Mailing Address - Phone:662-320-3903
Mailing Address - Fax:
Practice Address - Street 1:519 DR. MARTIN LUTHER KING, JR. DRIVE
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2747
Practice Address - Country:US
Practice Address - Phone:662-323-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1021779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional