Provider Demographics
NPI:1861099194
Name:YOUNG, NICHOLE ELIZABETH (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 JARROD AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-5003
Mailing Address - Country:US
Mailing Address - Phone:810-955-5477
Mailing Address - Fax:
Practice Address - Street 1:2030 RAHN WAY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2300
Practice Address - Country:US
Practice Address - Phone:612-400-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional