Provider Demographics
NPI:1487704094
Name:YOUNG, MICHELLE LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 172
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8600
Mailing Address - Country:US
Mailing Address - Phone:214-520-7007
Mailing Address - Fax:214-361-1929
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:SUITE 172
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-520-7007
Practice Address - Fax:214-361-1929
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12764101YM0800X
TX354851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026482201Medicaid
TX610525Medicare PIN