Provider Demographics
NPI:1427180710
Name:YOUNG, BEVERLY ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 ABRAMS PKWY
Mailing Address - Street 2:#394
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:214-537-8455
Mailing Address - Fax:214-823-1134
Practice Address - Street 1:6162 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 204
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2697
Practice Address - Country:US
Practice Address - Phone:214-537-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional