Provider Demographics
NPI:1528317575
Name:YOUNG, MEGHAN K (MA, MFTI)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ESTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1008
Mailing Address - Country:US
Mailing Address - Phone:727-743-9068
Mailing Address - Fax:
Practice Address - Street 1:1480 LINCOLN AVE
Practice Address - Street 2:#8
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2084
Practice Address - Country:US
Practice Address - Phone:727-743-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 71375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist