Healthcare Provider Details

I. General information

NPI: 1952068249
Provider Name (Legal Business Name): ELLEN L YOUNG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 GRANT ST FL 2
CRYSTAL LAKE IL
60014-4372
US

IV. Provider business mailing address

27 GRANT ST FL 2
CRYSTAL LAKE IL
60014-4372
US

V. Phone/Fax

Practice location:
  • Phone: 901-205-9395
  • Fax:
Mailing address:
  • Phone: 815-581-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139980
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018401
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: