Provider Demographics
NPI:1124847140
Name:YOUNGLOVE-BARANCIK, ALYSSA LYNN
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LYNN
Last Name:YOUNGLOVE-BARANCIK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:LYNN
Other - Last Name:BARANCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4050 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8416
Mailing Address - Country:US
Mailing Address - Phone:810-610-5742
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5113
Practice Address - Country:US
Practice Address - Phone:248-276-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator