Healthcare Provider Details

I. General information

NPI: 1982168662
Provider Name (Legal Business Name): KATHRYN YOUNG MA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 LOMAS BLVD NE APT 117D
ALBUQUERQUE NM
87112-6293
US

IV. Provider business mailing address

13400 LOMAS BLVD NE APT 117D
ALBUQUERQUE NM
87112-6293
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-5992
  • Fax:
Mailing address:
  • Phone: 505-717-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0201741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: