MEDICARE: KEVIN L YOUNG LPC

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	LPC006035	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740356013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN L YOUNG LPC

Provider Business Mailing Address
First Line	:	1821 TREE PARK CIR
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-2878
Country	:	US
Telephone Number	:	404-641-3089
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 PEACHFORD RD
Second Line	:	SUITE C
City	:	ATLANTA
State	:	GA
Zip	:	30338-7143
Country	:	US
Telephone Number	:	404-641-3089
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/14/2011

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Directions to “ KEVIN L YOUNG LPC” Practice Location

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