Provider Demographics
NPI:1649322108
Name:YOUNG, JEFFERSON DAVIS JR (LCP LCMFT LMLP)
Entity type:Individual
Prefix:MR
First Name:JEFFERSON
Middle Name:DAVIS
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:LCP LCMFT LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 WEST 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-9478
Mailing Address - Country:US
Mailing Address - Phone:785-625-7210
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH STREET
Practice Address - Street 2:HIGH PLAINS MENTAL HEALTH CENTER
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4117
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-0426
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP0161103T00000X
KSLCP234103T00000X
KSLCMFT121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist