Healthcare Provider Details

I. General information

NPI: 1023926383
Provider Name (Legal Business Name): LISA RACHEL YOUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N SAN VICENTE BLVD APT 101
WEST HOLLYWOOD CA
90069-3849
US

IV. Provider business mailing address

928 N SAN VICENTE BLVD APT 101
WEST HOLLYWOOD CA
90069-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-560-9387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131330
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95446846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: