Provider Demographics
NPI:1386104636
Name:YOUNKIN, DENNIS JAY
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAY
Last Name:YOUNKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1905
Mailing Address - Country:US
Mailing Address - Phone:248-524-8801
Mailing Address - Fax:248-524-8875
Practice Address - Street 1:2301 E MICHIGAN AVE STE 219
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3786
Practice Address - Country:US
Practice Address - Phone:517-782-0010
Practice Address - Fax:517-782-9695
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor