Provider Demographics
NPI:1699894188
Name:YOUNG, JINA L (MED, LADC, LPC)
Entity type:Individual
Prefix:
First Name:JINA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6805
Mailing Address - Country:US
Mailing Address - Phone:405-314-5128
Mailing Address - Fax:
Practice Address - Street 1:12109 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6805
Practice Address - Country:US
Practice Address - Phone:405-314-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK407101YA0400X
OK3675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)