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General NPI Number Information
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NPI Number | 1104625110
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Entity Type | Organization
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Legal Business Name | YOUNGBLOOD THERAPY LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 2470 SAINT ROSE PKWY STE 302
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City | HENDERSON
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State | NV
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Zip | 89074-7776
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Country | US
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Telephone | 702-241-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 503 BROKEN SHALE CIR
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City | HENDERSON
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State | NV
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Zip | 89052-2890
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Country | US
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Telephone | 702-241-7166
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Fax |
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Authorized Official
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Title or Position | OPERATOR/THERAPIST
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Name | STACY YOUNGBLOOD
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Credential | LMFT
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Telephone | 702-241-7166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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