Provider Demographics
NPI:1053512012
Name:YOUNG, EMILY JANE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 RIME VILLAGE DR NW APT 104
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2721
Mailing Address - Country:US
Mailing Address - Phone:256-774-8340
Mailing Address - Fax:256-774-8380
Practice Address - Street 1:9238 MADISON BLVD
Practice Address - Street 2:BULIDING ONE, SUITE 1300
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9100
Practice Address - Country:US
Practice Address - Phone:256-774-8340
Practice Address - Fax:256-774-8380
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor