Provider Demographics
NPI:1700602455
Name:YOUNG, ASHLEY (PLMHP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25103 PACIFIC CREST ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-3117
Mailing Address - Country:US
Mailing Address - Phone:505-918-2078
Mailing Address - Fax:
Practice Address - Street 1:11640 ARBOR ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5007
Practice Address - Country:US
Practice Address - Phone:505-918-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health