Active NPI
Diane Youngblood, M.ED.
- Mental Health Counselor
- Clarksdale, MS
National Provider Identifier
1346564523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1742 Cheryl St
Clarksdale, MS 38614-7218 - Phone
- (662) 627-7267
- Fax
- (662) 627-5240
- NPI assigned
- Mar 17, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1742 Cheryl St
Clarksdale, MS 38614-7218
Mailing address
PO Box 1046
Clarksdale, MS 38614-1046
Phone (662) 627-7267
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
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268784000000",
"number": "1346564523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1046",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386141046",
"telephone_number": "662-627-7267",
"fax_number": "662-627-5240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1742 CHERYL ST",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386147218",
"telephone_number": "662-627-7267",
"fax_number": "662-627-5240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBLOOD",
"first_name": "DIANE",
"credential": "M.ED.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-17",
"last_updated": "2010-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.