Provider Demographics
NPI:1316522618
Name:YOUNG, BRENDA ANN (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W PERALTA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8356
Mailing Address - Country:US
Mailing Address - Phone:602-487-5135
Mailing Address - Fax:
Practice Address - Street 1:665 W PERALTA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8356
Practice Address - Country:US
Practice Address - Phone:602-487-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22974101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor