Provider Demographics
NPI:1083754691
Name:YOURON, MICHAEL ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:YOURON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GILEAD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6820
Mailing Address - Country:US
Mailing Address - Phone:570-498-5515
Mailing Address - Fax:704-997-4996
Practice Address - Street 1:215 GILEAD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6820
Practice Address - Country:US
Practice Address - Phone:570-498-5515
Practice Address - Fax:704-997-4996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005923-L103T00000X
NC3809103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA667768OtherHIGHMARK BC/BS
PA078668OtherFIRST PRIORITY HEALTH HMO
PA7869127OtherAETNA
PA667768OtherHIGHMARK BC/BS