Provider Demographics
NPI: | 1033582184 |
---|---|
Name: | THOMAS D. YOUNG, LMHC |
Entity Type: | Organization |
Organization Name: | THOMAS D. YOUNG, LMHC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOTHERAPIST |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | DANIEL |
Authorized Official - Last Name: | YOUNG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS |
Authorized Official - Phone: | 443-995-5898 |
Mailing Address - Street 1: | 1432 MARTIN LUTHER KING ST N |
Mailing Address - Street 2: | |
Mailing Address - City: | ST PETERSBURG |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33704-3302 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-995-5898 |
Mailing Address - Fax: | 727-821-6914 |
Practice Address - Street 1: | 1432 MARTIN LUTHER KING ST N |
Practice Address - Street 2: | |
Practice Address - City: | ST PETERSBURG |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33704-3302 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-995-5898 |
Practice Address - Fax: | 727-821-6914 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-11-10 |
Last Update Date: | 2015-11-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | MH9706 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |