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General NPI Number Information
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NPI Number | 1902534860
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Entity Type | Individual
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Provider Name | JESSICA ANTONIA YOUNG
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 4522 NE 13TH ST
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City | OCALA
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State | FL
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Zip | 34470-2006
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Country | US
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Telephone | 904-302-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 10 MASON ST
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City | GRETNA
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State | LA
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Zip | 70053-7016
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Country | US
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Telephone | 904-302-0966
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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