Bradley David Young, LCMHC

Key facts

NPI

1083930697

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

License

068.0056573 (VT)

Practice address

50 Kendall Ave
Rutland, VT 05701-3117

Phone

(802) 353-3421

NPI assigned

Apr 8, 2010

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083930697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 KENDALL AVE",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "05701",
            "telephone_number": "802-353-3421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 KENDALL AVE",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057013117",
            "telephone_number": "802-353-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "BRADLEY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "068.0056573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Rutland, VT · Mental Health Counselor in Vermont