Provider Demographics
NPI:1184943359
Name:YOUNG, JENNIFER R (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 169
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-8173
Mailing Address - Country:US
Mailing Address - Phone:727-642-2189
Mailing Address - Fax:
Practice Address - Street 1:1301 SEMINOLE BLVD
Practice Address - Street 2:SUITE 169
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-8173
Practice Address - Country:US
Practice Address - Phone:727-642-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health