Shane G. Young, MA, NCC, LPC
Counselor, Professional in Peoria, IL. Individual provider (NPI-1).
NPI number1194337147
StatusActive
Last updated in NPPESAug 20, 2020
Details
- NPI
- 1194337147
- Entity type
- Individual (NPI-1)
- Name
- Shane G. Young
- Credential
- MA, NCC, LPC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 20, 2020
- Certification date
- Aug 20, 2020
- Last updated
- Aug 20, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 178015348 | IL | Yes |
Practice location
3020 W Willow Knolls DrPeoria, IL 61614-8127
Phone 309-681-5850
Mailing address
Po Box 335Glasford, IL 61533-0335
Phone 309-202-4417
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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