Provider Demographics
NPI:1932404621
Name:SUH, RA YOUNG (LCSW)
Entity type:Individual
Prefix:
First Name:RA
Middle Name:YOUNG
Last Name:SUH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4300
Mailing Address - Country:US
Mailing Address - Phone:417-823-2900
Mailing Address - Fax:417-886-2774
Practice Address - Street 1:1540 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4300
Practice Address - Country:US
Practice Address - Phone:417-823-2900
Practice Address - Fax:417-886-2774
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200379231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical