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General NPI Number Information
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NPI Number | 1609006766
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Entity Type | Individual
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Provider Name | MITCHELL JOHN YOUNG LMHC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 412 S MAPLE ST STE 103
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City | FORTVILLE
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State | IN
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Zip | 46040-1681
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Country | US
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Telephone | 317-360-5641
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Fax | 317-412-9130
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Provider Business Mailing Address
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Address Line | 412 S MAPLE ST STE 103
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City | FORTVILLE
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State | IN
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Zip | 46040-1681
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Country | US
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Telephone | 317-360-5641
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Fax | 317-412-9130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.0007959
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 39003348A
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License Number State | IN
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