Provider Demographics
NPI:1992805584
Name:YOUNG, ANDREA MARIE (LMHP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OLSON DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4797
Mailing Address - Country:US
Mailing Address - Phone:402-991-1441
Mailing Address - Fax:402-991-1889
Practice Address - Street 1:701 OLSON DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4797
Practice Address - Country:US
Practice Address - Phone:402-991-1441
Practice Address - Fax:402-991-1889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251361-00Medicaid