=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457823429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVYANA S YOUNG LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2019
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 TOLL GATE RD STE 309
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-684-8053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 MAIN ST APT 3
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02885-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-204-5999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------