Provider Demographics
NPI:1093073702
Name:YOUNG, MARY E (MA, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5721
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5721
Mailing Address - Country:US
Mailing Address - Phone:405-792-0229
Mailing Address - Fax:
Practice Address - Street 1:LIFEWORKS COUNSELING SERVICES
Practice Address - Street 2:2500 S BROADWAY, STE 340B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-792-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OK1151LMFT106H00000X
OK6297LPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist