Provider Demographics
NPI:1740328210
Name:YOUNG, LEANNE (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4307
Mailing Address - Country:US
Mailing Address - Phone:406-360-3262
Mailing Address - Fax:
Practice Address - Street 1:229 KEITH AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4307
Practice Address - Country:US
Practice Address - Phone:406-360-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT07445-3OtherBLUE CROSSBLUE SHIELD MT
MT0256282Medicaid