Provider Demographics
NPI:1700802238
Name:YOUNG, GLENDA JEAN (LCP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2833
Mailing Address - Country:US
Mailing Address - Phone:785-229-6949
Mailing Address - Fax:
Practice Address - Street 1:204 E 15TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3903
Practice Address - Country:US
Practice Address - Phone:785-242-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS----101YA0400X
KS222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical