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General NPI Number Information
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NPI Number | 1275014847
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Entity Type | Organization
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Legal Business Name | RENEE P YOUNG, MS, LMFT, LLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 222 E GRAND AVE STE 300
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City | PONCA CITY
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State | OK
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Zip | 74601-4316
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Country | US
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Telephone | 405-939-0559
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Fax | 580-916-9538
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Provider Business Mailing Address
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Address Line | 2412 DONNER AVE.
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City | PONCA CITY
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State | OK
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Zip | 74604
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Country | US
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Telephone | 580-304-2069
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Fax | 580-916-9538
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Authorized Official
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Title or Position | OWNER
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Name | RENEE PAULINE YOUNG
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Credential | MS, LMFT
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Telephone | 580-304-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1136
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1136
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License Number State | OK
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