Provider Demographics
NPI:1154335149
Name:ASHFORD,SIMMONS, & YOUNG COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ASHFORD,SIMMONS, & YOUNG COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER CLINICAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED
Authorized Official - Phone:803-254-1210
Mailing Address - Street 1:1825 SAINT JULIAN PL UNIT F1D-E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2424
Mailing Address - Country:US
Mailing Address - Phone:803-254-1210
Mailing Address - Fax:
Practice Address - Street 1:1825 SAINT JULIAN PL UNIT F1D-E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2424
Practice Address - Country:US
Practice Address - Phone:803-254-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP 4005Medicaid