Provider Demographics
NPI:1386650224
Name:YOUNG, JENNIFER DARA (MC, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DARA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:DARA
Other - Last Name:MAULFAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:4901 W BELL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3465
Mailing Address - Country:US
Mailing Address - Phone:602-978-0945
Mailing Address - Fax:602-843-8028
Practice Address - Street 1:4901 W BELL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3465
Practice Address - Country:US
Practice Address - Phone:602-978-0945
Practice Address - Fax:602-843-8028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC - 2425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ757750OtherAHCCCS
AZ506812OtherMHS
AZMHNOther308122
AR252952OtherCOMPSYCH