Basic Information
| Provider Information | |||||||||
| NPI: | 1881934974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | LORRIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 N EISENHOWER AVE | ||||||||
| Address2: | PO BOX 1338 | ||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414242391 | ||||||||
| FaxNumber: | 6414240783 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 N EISENHOWER AVE | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414242391 | ||||||||
| FaxNumber: | 6414240783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 03686 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.