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General NPI Number Information
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NPI Number | 1902972789
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Entity Type | Individual
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Provider Name | ELLEN L. YOUNGHAUS L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 11/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5942 34TH ST W
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City | BRADENTON
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State | FL
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Zip | 34210-3683
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Country | US
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Telephone | 941-782-4860
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Fax | 941-782-4899
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Provider Business Mailing Address
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Address Line | 4728 SABAL KEY DR
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City | BRADENTON
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State | FL
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Zip | 34203-3123
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Country | US
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Telephone | 941-739-0482
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Fax | 941-782-4899
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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 | MH 7834
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License Number State | FL
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