Healthcare Provider Details

I. General information

NPI: 1407105307
Provider Name (Legal Business Name): AMY LYNN YOUNG M.ED., NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMY LYNN WARNER

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 S EASON BLVD
TUPELO MS
38804-6942
US

IV. Provider business mailing address

2434 S EASON BLVD
TUPELO MS
38804-6942
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-1717
  • Fax: 662-680-6416
Mailing address:
  • Phone: 662-844-1717
  • Fax: 662-680-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: