Provider Demographics
NPI:1083230981
Name:CARSON-YOUNG, JOANNA LEIGH (LMFT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LEIGH
Last Name:CARSON-YOUNG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1225
Mailing Address - Country:US
Mailing Address - Phone:408-859-9631
Mailing Address - Fax:
Practice Address - Street 1:1769 PARK AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2025
Practice Address - Country:US
Practice Address - Phone:408-520-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist