Provider Demographics
NPI:1952885436
Name:YOUNG, JENNIE R (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 S MARQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3807
Mailing Address - Country:US
Mailing Address - Phone:334-202-5015
Mailing Address - Fax:
Practice Address - Street 1:5510 WARES FERRY RD STE U
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2131
Practice Address - Country:US
Practice Address - Phone:334-387-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health