Active NPI
Kristin Irene Young, MSSW LCSW
- Clinical Social Worker
- Marion, AR
National Provider Identifier
1144300823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2225-C
- Practice address
- 106 Cypress Ave
East Arkansas Youth Services
Marion, AR 72364 - Phone
- (870) 739-4219
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 8403 | FL | |
| Clinical Social Worker | 1041C0700X | 2225-C | AR | Primary |
| Clinical Social Worker | 1041C0700X | LSW0000004978 | TN |
Addresses
Primary practice location
106 Cypress Ave
East Arkansas Youth Services
Marion, AR 72364
Mailing address
5060 Alrose Ave
Memphis, TN 38117-5802
Phone (901) 481-1750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7684118 00 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2225-C | AR | MD | Clinical Social Worker |
| SW 8403 | FL | MD | Clinical Social Worker |
| LSW0000004978 | TN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1144300823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5060 ALROSE AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381175802",
"telephone_number": "901-481-1750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 CYPRESS AVE",
"address_2": "EAST ARKANSAS YOUTH SERVICES",
"city": "MARION",
"state": "AR",
"postal_code": "72364",
"telephone_number": "870-739-4219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "KRISTIN",
"middle_name": "IRENE",
"name_prefix": "Mrs.",
"credential": "MSSW LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW 8403",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "2225-C",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "LSW0000004978",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7684118 00",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.