Healthcare Provider Details

I. General information

NPI: 1033471479
Provider Name (Legal Business Name): SANDRA L YOUNG LMHP, LADC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N BAILEY AVE
NORTH PLATTE NE
69101-5436
US

IV. Provider business mailing address

110 N BAILEY AVE
NORTH PLATTE NE
69101-5436
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-6029
  • Fax:
Mailing address:
  • Phone: 308-534-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1062
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4443
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2162
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: