Healthcare Provider Details

I. General information

NPI: 1265360879
Provider Name (Legal Business Name): KENDALL OLIVIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 E ALTAMONTE DR STE 108251
ALTAMONTE SPRINGS FL
32701-4628
US

IV. Provider business mailing address

1150 N LIBERTY ST
JACKSONVILLE FL
32206-5132
US

V. Phone/Fax

Practice location:
  • Phone: 786-432-5464
  • Fax:
Mailing address:
  • Phone: 813-409-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: