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General NPI Number Information
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NPI Number | 1689413775
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Entity Type | Individual
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Provider Name | PHILIP ROY YOUNGER
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 19344 N 10TH ST
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City | COVINGTON
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State | LA
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Zip | 70433-8877
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Country | US
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Telephone | 985-276-4165
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Fax | 985-400-2333
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Provider Business Mailing Address
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Address Line | PO BOX 1152
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City | MANDEVILLE
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State | LA
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Zip | 70470-1152
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Country | US
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Telephone | 985-200-3999
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Fax | 985-400-2333
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 768
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License Number State | LA
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