Provider Demographics
NPI:1881300556
Name:YOUNG, SYDNEY CARTWRIGHT
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:CARTWRIGHT
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 S NORTH MILLSITE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9737
Mailing Address - Country:US
Mailing Address - Phone:573-424-7556
Mailing Address - Fax:
Practice Address - Street 1:201 W BROADWAY STE 2F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3842
Practice Address - Country:US
Practice Address - Phone:573-214-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028389101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor