Healthcare Provider Details

I. General information

NPI: 1902972789
Provider Name (Legal Business Name): ELLEN L. YOUNGHAUS L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5942 34TH ST W
BRADENTON FL
34210-3683
US

IV. Provider business mailing address

4728 SABAL KEY DR
BRADENTON FL
34203-3123
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4860
  • Fax: 941-782-4899
Mailing address:
  • Phone: 941-739-0482
  • Fax: 941-782-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 7834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: