Provider Demographics
NPI:1417626748
Name:YOU, MI JUNG (LMHC)
Entity Type:Individual
Prefix:
First Name:MI JUNG
Middle Name:
Last Name:YOU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 CURZON RD APT 6A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3496
Mailing Address - Country:US
Mailing Address - Phone:917-497-4024
Mailing Address - Fax:
Practice Address - Street 1:4332 22ND ST STE 203
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5077
Practice Address - Country:US
Practice Address - Phone:917-497-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004834-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15812852400OtherUNITED HEALTHCARE