Provider Demographics
NPI:1982015475
Name:YOUNG, MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 ALVATON RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122
Mailing Address - Country:US
Mailing Address - Phone:270-746-6600
Mailing Address - Fax:270-842-9008
Practice Address - Street 1:9940 ALVATON RD
Practice Address - Street 2:
Practice Address - City:ALVATON
Practice Address - State:KY
Practice Address - Zip Code:42122
Practice Address - Country:US
Practice Address - Phone:270-746-6600
Practice Address - Fax:270-842-9008
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0874106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist