Provider Demographics
NPI:1528881240
Name:YOUNG, JASMINE N (EDS, LPCA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:N
Last Name:YOUNG
Suffix:
Gender:F
Credentials:EDS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 MORAINE CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4601
Mailing Address - Country:US
Mailing Address - Phone:502-612-5970
Mailing Address - Fax:
Practice Address - Street 1:1330 ELLISON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1657
Practice Address - Country:US
Practice Address - Phone:502-694-9488
Practice Address - Fax:502-276-0926
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional