Healthcare Provider Details

I. General information

NPI: 1346524964
Provider Name (Legal Business Name): DEANN JENIFER YOUNT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANN ALEXANDER

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GRAVOIS RD
HOUSE SPRINGS MO
63051-2304
US

IV. Provider business mailing address

227 E MAIN ST
FESTUS MO
63028-1952
US

V. Phone/Fax

Practice location:
  • Phone: 636-321-0150
  • Fax: 636-375-5157
Mailing address:
  • Phone: 636-931-2700
  • Fax: 636-931-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005599
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: