Healthcare Provider Details

I. General information

NPI: 1952851362
Provider Name (Legal Business Name): PAUL JEFFREY YOUNG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 COUNTY ROAD DF FL 3
JUNEAU WI
53039-9512
US

IV. Provider business mailing address

199 COUNTY ROAD DF FL 3
JUNEAU WI
53039-9512
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-3513
  • Fax:
Mailing address:
  • Phone: 920-386-3513
  • Fax: 920-386-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6262-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: