Provider Demographics
NPI:1730526419
Name:YOUNG, LESLIE MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14362 107TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8905
Mailing Address - Country:US
Mailing Address - Phone:182-831-3715
Mailing Address - Fax:
Practice Address - Street 1:14362 107TH ST SE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8905
Practice Address - Country:US
Practice Address - Phone:182-831-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC00596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1730526419Medicaid