MEDICARE: RICHARD C YOUNG LCSW INC

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	251S00000X	Community/Behavioral Health Agency	2006022838	MO

General Provider Information

NPI Number	:	1699182592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD C YOUNG LCSW INC

Provider Business Mailing Address
First Line	:	412 S CLAY AVE
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-5860
Country	:	US
Telephone Number	:	314-550-2251
Fax Number	:	314-822-9696

Provider Business Practice Location Address
First Line	:	412 S CLAY AVE
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-5860
Country	:	US
Telephone Number	:	314-550-2251
Fax Number	:	314-822-9696

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD CHARLES YOUNG
Credential	:	LCSW
Telephone Number	:	314-550-2251

Provider Enumeration Date	:	07/13/2014
Last Update Date	:	07/13/2014

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