Provider Demographics
NPI:1588792493
Name:MARY KAY YOUNG, LMHC, INC.
Entity type:Organization
Organization Name:MARY KAY YOUNG, LMHC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-269-0886
Mailing Address - Street 1:1724 VILLAGE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5264
Mailing Address - Country:US
Mailing Address - Phone:904-269-0886
Mailing Address - Fax:
Practice Address - Street 1:1417 SADLER RD
Practice Address - Street 2:#164
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4466
Practice Address - Country:US
Practice Address - Phone:904-583-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty