Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor |
NPI | 1245874312 |
---|---|
Provider Name | Mr. John S Young JR. |
First Address | Stuart, FL 34996-3337 |
Second Address | Stuart, FL 34996-3337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2019 |
Last Update Date | 01/11/2019 |