Provider Demographics
NPI:1982878419
Name:YOUNG, PHILIP WAYNE II (LPC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:WAYNE
Last Name:YOUNG
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6174
Mailing Address - Country:US
Mailing Address - Phone:972-315-2082
Mailing Address - Fax:
Practice Address - Street 1:2148 GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6174
Practice Address - Country:US
Practice Address - Phone:972-315-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional