Basic Information
| Provider Information | |||||||||
| NPI: | 1720687759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 319 | ||||||||
| Address2: | |||||||||
| City: | BIGLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168250319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 INDUSTRIAL PARK RD | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168306016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147651149 | ||||||||
| FaxNumber: | 8147659542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC012741 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.