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General NPI Number Information
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NPI Number | 1588792493
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Entity Type | Organization
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Legal Business Name | MARY KAY YOUNG, LMHC, INC.
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1417 SADLER RD #164
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4466
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Country | US
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Telephone | 904-583-0349
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 VILLAGE WAY SUITE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-5264
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Country | US
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Telephone | 904-269-0886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARY KAY YOUNG
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Credential | LMHC
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Telephone | 904-269-0886
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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 | 2494
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License Number State | FL
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