Provider Demographics
NPI:1427631126
Name:YOUNGMAN, DANA MARIE (LMLP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2139
Mailing Address - Country:US
Mailing Address - Phone:785-460-7588
Mailing Address - Fax:785-460-2396
Practice Address - Street 1:485 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2139
Practice Address - Country:US
Practice Address - Phone:785-460-7588
Practice Address - Fax:785-460-2396
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS03031OtherBSRB