Shane G. Young, MA, NCC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178015348 Issued in IL

Practice address

3020 W Willow Knolls Dr
Peoria, IL 61614-8127

Phone

(309) 681-5850

NPI assigned

Aug 20, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neurotherapy Institute, PLLC

  • Professional Counselor
  • Peoria, IL
  • NPI 1497556286
  NPD Authorized official

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1194337147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 335",
            "city": "GLASFORD",
            "state": "IL",
            "postal_code": "615330335",
            "telephone_number": "309-202-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 W WILLOW KNOLLS DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148127",
            "telephone_number": "309-681-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "SHANE",
        "middle_name": "G.",
        "credential": "MA, NCC, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-20",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178015348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Youmans, D.O.
• Bernice Young, LPC
• Jessica B Young, PA-C
• Joshua Young, M.S. ED
• Leann B Young, PAC
• Austin Youngman, RD, LDN
• Laura A Youngman, APN
• Youth Farm Inc
• Sheng Nan Yu, OD
• K'la Dawn Yuan

• Professional Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.