Provider Demographics
NPI:1194551200
Name:YOUNG, STEPHANIE LEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:BAR NUNN
Mailing Address - State:WY
Mailing Address - Zip Code:82601-9436
Mailing Address - Country:US
Mailing Address - Phone:432-256-0570
Mailing Address - Fax:
Practice Address - Street 1:5913 MISSY LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-1624
Practice Address - Country:US
Practice Address - Phone:432-256-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator