MEDICARE: LAURA ELLEN YOUNG PSY.D.

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	103TC0700X	Clinical Psychologist	KY1295	KY

General Provider Information

NPI Number	:	1043408487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELLEN YOUNG PSY.D.

Provider Business Mailing Address
First Line	:	5709 SPRING HILL CT
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8525
Country	:	US
Telephone Number	:	502-836-5770
Fax Number	:	502-749-4590

Provider Business Practice Location Address
First Line	:	5709 SPRING HILL CT
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8525
Country	:	US
Telephone Number	:	502-836-5770
Fax Number	:	502-749-4590

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

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	08/06/2015

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