Healthcare Provider Details

I. General information

NPI: 1275465254
Provider Name (Legal Business Name): KYRSTEN YOUNGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 THAYER ST
LITTLE ROCK AR
72205-5951
US

IV. Provider business mailing address

117 THAYER ST
LITTLE ROCK AR
72205-5951
US

V. Phone/Fax

Practice location:
  • Phone: 501-285-2404
  • Fax:
Mailing address:
  • Phone: 501-285-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11937-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: