Healthcare Provider Details

I. General information

NPI: 1689372732
Provider Name (Legal Business Name): JENNIFER YOUNGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N GURLEY AVE
GILLETTE WY
82716-2109
US

IV. Provider business mailing address

905 N GURLEY AVE
GILLETTE WY
82716-2109
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-0669
  • Fax:
Mailing address:
  • Phone: 307-686-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC-1368
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: