Provider Demographics
NPI:1467519777
Name:YOUNG, JOE MICHAEL SR (MA)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:MICHAEL
Last Name:YOUNG
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9717
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0031
Mailing Address - Country:US
Mailing Address - Phone:479-521-9902
Mailing Address - Fax:479-521-9902
Practice Address - Street 1:1932 S GARLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6841
Practice Address - Country:US
Practice Address - Phone:479-521-9902
Practice Address - Fax:479-521-9902
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM9802013106H00000X
ARP9508020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist