KELLY JANE YOUNG CRADC NPI 1104588177

NPI Information

NPI: 1104588177
Provider Name: KELLY JANE YOUNG, CRADC
Classification: Clinic/Center - 261QR0405X
Entity Type: Individual

Specialization: Rehabilitation, Substance Use Disorder

Address:
501 S PENNSYLVANIA AVE
JOPLIN, MO
ZIP 64801
Phone: (417) 553-0043
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Kelly Jane Young, CRADC is a rehabilitation and substance use disorder clinic center in Joplin, MO. Kelly Jane Young, CRADC NPI is 1104588177. The provider is registered as an individual entity type and is a multiple single specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

501 S PENNSYLVANIA AVE
JOPLIN, MO
ZIP 64801-286
Phone: (417) 553-0043
Fax: (417) 553-0081

The enumeration date for this NPI number is 10/7/2021 and was last updated on 10/7/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	4486	MISSOURI	No
2	175T00000X	Peer Specialist		10017		No
3	261QM0850X	Clinic/Center	Adult Mental Health	2821	MISSOURI	No
4	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	2821	MISSOURI	No
5	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	2821	MISSOURI	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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