Healthcare Provider Details

I. General information

NPI: 1568795219
Provider Name (Legal Business Name): GENIA LETICIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

IV. Provider business mailing address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

V. Phone/Fax

Practice location:
  • Phone: 323-457-3037
  • Fax:
Mailing address:
  • Phone: 323-457-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number14240
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: