Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2817 | LA |
NPI | 1003861683 |
---|---|
Provider Name | Ean Vincenzo Young |
First Address | Scott, LA 70583-5655 |
Second Address | Lafayette, LA 70501-6942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 05/05/2009 |