Provider Demographics
NPI:1386950095
Name:YOUNG, SHERILYN MICHELE (LPCC, MCA, CSC)
Entity type:Individual
Prefix:MS
First Name:SHERILYN
Middle Name:MICHELE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LPCC, MCA, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 SEABRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433
Mailing Address - Country:US
Mailing Address - Phone:805-458-6776
Mailing Address - Fax:805-354-1552
Practice Address - Street 1:1180 A GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-458-6776
Practice Address - Fax:805-354-1552
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
CA60651106H00000X
CALPC207101YP2500X, 101YM0800X
CAMFTI60651106H00000X
CAYO412151234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health