Provider Demographics
NPI:1194694448
Name:BOLTON-YOUNG, TUJOHNNA CHANEL (LPC)
Entity type:Individual
Prefix:
First Name:TUJOHNNA
Middle Name:CHANEL
Last Name:BOLTON-YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 TAMPICO DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3510
Mailing Address - Country:US
Mailing Address - Phone:618-910-3956
Mailing Address - Fax:
Practice Address - Street 1:2012 TAMPICO DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-3510
Practice Address - Country:US
Practice Address - Phone:618-910-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional