MEDICARE: MS. CHASTITY NICOLE YOUNG LPC LMFT

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	101YP2500X	Professional Counselor	3868	LA
2	106H00000X	Marriage & Family Therapist	1131	LA

General Provider Information

NPI Number	:	1215261185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHASTITY NICOLE YOUNG LPC LMFT

Provider Business Mailing Address
First Line	:	100 FORDOCHE PL
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-1708
Country	:	US
Telephone Number	:	985-778-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S JEFFERSON AVE
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-3169
Country	:	US
Telephone Number	:	985-778-4978
Fax Number	:

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

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/08/2011

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