Healthcare Provider Details

I. General information

NPI: 1932210663
Provider Name (Legal Business Name): KEVIN W YOUNG, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N AVENUE F
CROWLEY LA
70526-5042
US

IV. Provider business mailing address

325 N AVENUE F
CROWLEY LA
70526-5042
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-5262
  • Fax: 337-783-5264
Mailing address:
  • Phone: 337-783-5262
  • Fax: 337-783-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number09967R
License Number StateLA

VIII. Authorized Official

Name: DR. KEVIN W YOUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 337-783-5262