Provider Demographics
NPI:1275654196
Name:YOUNG, LISA (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11774 CPL ANTHONY J CARSON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79908-3227
Mailing Address - Country:US
Mailing Address - Phone:915-929-6816
Mailing Address - Fax:
Practice Address - Street 1:6500 BOEING DR
Practice Address - Street 2:SUITE L-150
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1009
Practice Address - Country:US
Practice Address - Phone:915-779-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3034101YM0800X
TX65677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65677OtherLPC