Healthcare Provider Details

I. General information

NPI: 1629428305
Provider Name (Legal Business Name): ZAUNDREA L YOUNG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11102 LINDBERGH BUSINESS CT
SAINT LOUIS MO
63123-7810
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3400
  • Fax:
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-206-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023009169
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: