Healthcare Provider Details

I. General information

NPI: 1164331997
Provider Name (Legal Business Name): SAMANTHA RAE YOUNG LAC, LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15564 DEERFIELD ST
STERLING CO
80751-8761
US

IV. Provider business mailing address

15564 DEERFIELD ST
STERLING CO
80751-8761
US

V. Phone/Fax

Practice location:
  • Phone: 970-580-9222
  • Fax:
Mailing address:
  • Phone: 970-580-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002948
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: