Individual Healthcare Provider
Kelly Jane Young, CRADC
Provider's NPPES record last updated: October 7, 2021
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1104588177
- Primary Specialty
- Clinic/Center — Rehabilitation, Substance Use Disorder
- Practice Location
- Joplin, Missouri
- Sole Proprietor
- Yes
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 21, 2026, 8:32 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Clinic/Center
Rehabilitation, Substance Use Disorder
Ambulatory Health Care Facilities
Definition to come...
Taxonomy code 261QR0405X Counselor
Addiction (Substance Use Disorder)
Behavioral Health & Social Service Providers
Definition to come...
Taxonomy code 101YA0400XPeer Specialist
Other Service Providers
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Taxonomy code 175T00000XClinic/Center
Adult Mental Health
Ambulatory Health Care Facilities
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
Taxonomy code 261QM0850XClinic/Center
Adolescent and Children Mental Health
Ambulatory Health Care Facilities
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Taxonomy code 261QM0855X
Provider-Reported License Information
- Clinic/Center (Missouri)
- 2821
- Counselor (Missouri)
- 4486
- Peer Specialist
- 10017
- Clinic/Center (Missouri)
- 2821
- Clinic/Center (Missouri)
- 2821
Practice Locations
Practice Location
501 S Pennsylvania Ave
Joplin, Missouri 64801-2286
Phone: (417) 553-0043
Record Information
- Enumeration Date
- October 7, 2021
- Provider's NPPES Record Last Updated
- October 7, 2021
- Certification Date
- October 7, 2021
- NPISignal NPPES Dataset
- August 2026
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