Provider Demographics
NPI:1386102663
Name:YOUNG, KELSIE TEE (LPC-1975)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:TEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC-1975
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-5030
Mailing Address - Country:US
Mailing Address - Phone:307-421-1628
Mailing Address - Fax:
Practice Address - Street 1:309 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-5030
Practice Address - Country:US
Practice Address - Phone:307-421-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WYLPC-1975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor