Provider Demographics
NPI:1437462827
Name:YOUNG, MARY ELIZABETH (LPC, LCDC)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:1202 S FM116 COPPERAS COVE
Mailing Address - Street 2:APT 1104
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3604
Mailing Address - Country:US
Mailing Address - Phone:214-234-6453
Mailing Address - Fax:
Practice Address - Street 1:1202 S FM116 COPPERAS COVE
Practice Address - Street 2:APT 1104
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3604
Practice Address - Country:US
Practice Address - Phone:214-234-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist