Provider Demographics
NPI:1275258196
Name:YOUNG, BRIAN GALEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GALEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 S TROTTER LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-9146
Mailing Address - Country:US
Mailing Address - Phone:928-853-9939
Mailing Address - Fax:
Practice Address - Street 1:3240 S TROTTER LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-9146
Practice Address - Country:US
Practice Address - Phone:928-853-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2GH1-XF2-DX13Medicaid