Healthcare Provider Details

I. General information

NPI: 1003861683
Provider Name (Legal Business Name): EAN VINCENZO YOUNG LPC, LMFT, CEAP, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JEFFERSON ST SUITE 902
LAFAYETTE LA
70501-6942
US

IV. Provider business mailing address

104 OLIVE VISTA DR
SCOTT LA
70583-5655
US

V. Phone/Fax

Practice location:
  • Phone: 337-993-0000
  • Fax: 337-354-2410
Mailing address:
  • Phone: 337-501-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2817
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number236
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: