Provider Demographics
NPI:1013906197
Name:YOUNG, MITZI HEDRICK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MITZI
Middle Name:HEDRICK
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 REMINGTON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3074
Mailing Address - Country:US
Mailing Address - Phone:970-218-9902
Mailing Address - Fax:
Practice Address - Street 1:503 REMINGTON ST
Practice Address - Street 2:STE 104
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3074
Practice Address - Country:US
Practice Address - Phone:970-218-9902
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9925461041C0700X
WYLCSW1691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical