Provider Demographics
NPI:1336987585
Name:YOUNGBLOOD, CATHERINE JOHANNA (LMSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOHANNA
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 W STAGELINE RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-3886
Mailing Address - Country:US
Mailing Address - Phone:208-892-9090
Mailing Address - Fax:
Practice Address - Street 1:301 S WAY AVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979-2134
Practice Address - Country:US
Practice Address - Phone:402-773-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor