MEDICARE: MRS. MITZI HEDRICK YOUNG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	992546	CO
2	1041C0700X	Clinical Social Worker	LCSW169	WY

General Provider Information

NPI Number	:	1013906197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MITZI HEDRICK YOUNG LCSW

Provider Business Mailing Address
First Line	:	503 REMINGTON ST
Second Line	:	STE 104
City	:	FT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-218-9902
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 REMINGTON ST
Second Line	:	STE 104
City	:	FT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-218-9902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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