Provider Demographics
NPI:1194555789
Name:YOUNG, SIERRA JACLYN (PLPC)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:JACLYN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 BOONES LICK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2244
Mailing Address - Country:US
Mailing Address - Phone:636-697-2135
Mailing Address - Fax:
Practice Address - Street 1:15455 CONWAY RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6022
Practice Address - Country:US
Practice Address - Phone:636-697-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024029646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health