Provider Demographics
NPI:1487736682
Name:DEYOUNG CONSULTING INC.
Entity type:Organization
Organization Name:DEYOUNG CONSULTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DEYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:817-656-5544
Mailing Address - Street 1:4928 PARK BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5412
Mailing Address - Country:US
Mailing Address - Phone:817-988-8242
Mailing Address - Fax:817-656-5544
Practice Address - Street 1:4928 PARK BROOK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-5412
Practice Address - Country:US
Practice Address - Phone:817-988-8242
Practice Address - Fax:817-656-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028434101Medicaid