Shani A Young, LIFE COACH

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20467-130 Issued in WI

Practice address

5104 N 20TH St
Milwaukee, WI 53209-5717

Phone

(414) 630-1169

NPI assigned

Jul 17, 2022

Reactivated

Jan 23, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1124753959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 N 20TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532095717",
            "telephone_number": "414-630-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 N 20TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532095717",
            "telephone_number": "414-630-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "SHANI",
        "middle_name": "A",
        "credential": "LIFE COACH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-17",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "deactivation_date": "2024-01-18",
        "reactivation_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20467-130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI STATE DSPS",
            "identifier": "101YA0400X",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATIONAL COURSE",
            "identifier": "171400000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas David Young, PHD
• Riley Young
• Robert E Young, PSY.D.
• Robin Young
• Shaina Geanetta Young
• Sheree Monique Young, APRN FNP
• Vanessa Ann Young, LPN
• Vankiesha Young
• Zeyah Kenya Young, B.S.W. SOCIAL WORKER
• Your Best Self Psychotherapy, LLP

• Addiction (Substance Use Disorder) Counselor in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.