Healthcare Provider Details

I. General information

NPI: 1811238033
Provider Name (Legal Business Name): NAKETA LISETTE YOUNG M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 06/20/2024
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 CALUMET AVE
MUNSTER IN
46321-1704
US

IV. Provider business mailing address

10604 ONTARIO DR
CROWN POINT IN
46307-7654
US

V. Phone/Fax

Practice location:
  • Phone: 219-201-1852
  • Fax:
Mailing address:
  • Phone: 219-201-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: