Provider Demographics
NPI:1487880605
Name:YOUNG, SHIRLEY H (GSW)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:F
Credentials:GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WICHERS DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3041
Mailing Address - Country:US
Mailing Address - Phone:504-371-0260
Mailing Address - Fax:504-371-0249
Practice Address - Street 1:4700 WICHERS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3041
Practice Address - Country:US
Practice Address - Phone:504-371-0260
Practice Address - Fax:504-371-0249
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical