Healthcare Provider Details

I. General information

NPI: 1639504988
Provider Name (Legal Business Name): TAELOR F. YOUNG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S CHURCH ST
JONESBORO AR
72401-2913
US

IV. Provider business mailing address

501 SOUTHWEST DR # A1
JONESBORO AR
72401-5858
US

V. Phone/Fax

Practice location:
  • Phone: 870-790-1707
  • Fax:
Mailing address:
  • Phone: 870-930-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP1906078
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1906078
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: