Individual
CHARISSA YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901
(573) 686-1200
Mailing address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
2018019792
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033522412
—
MO
Enumeration date
06/03/2014
Last updated
06/16/2018
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