Provider Demographics
NPI:1881877322
Name:YOUNGBLOOD, GAELA (PSYD)
Entity type:Individual
Prefix:DR
First Name:GAELA
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 MAGNOLIA BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-1203
Mailing Address - Country:US
Mailing Address - Phone:318-453-6170
Mailing Address - Fax:
Practice Address - Street 1:2112 BIENVILLE BLVD STE J
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3067
Practice Address - Country:US
Practice Address - Phone:228-875-1590
Practice Address - Fax:228-875-1591
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS53938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical