Provider Demographics
NPI:1043408487
Name:YOUNG, LAURA ELLEN (PSYD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 SPRING HILL CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8525
Mailing Address - Country:US
Mailing Address - Phone:502-836-5770
Mailing Address - Fax:502-749-4590
Practice Address - Street 1:5709 SPRING HILL CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8525
Practice Address - Country:US
Practice Address - Phone:502-836-5770
Practice Address - Fax:502-749-4590
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical