Provider Demographics
NPI:1063421824
Name:YOUNG, KAREN IRENE (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:IRENE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 METROPOLITAN PKWY
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4105
Mailing Address - Country:US
Mailing Address - Phone:586-795-3232
Mailing Address - Fax:586-795-5540
Practice Address - Street 1:5528 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4105
Practice Address - Country:US
Practice Address - Phone:586-795-3232
Practice Address - Fax:586-795-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N66990Medicare ID - Type Unspecified
P16387Medicare UPIN