Provider Demographics
NPI:1669119293
Name:YOUNG, KALENCIA DENISE (PSYD, MTH)
Entity type:Individual
Prefix:DR
First Name:KALENCIA
Middle Name:DENISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD, MTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6335
Mailing Address - Country:US
Mailing Address - Phone:318-512-0169
Mailing Address - Fax:
Practice Address - Street 1:303 W HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6335
Practice Address - Country:US
Practice Address - Phone:318-512-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAKY860081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist