Provider Demographics
NPI:1548561525
Name:YOUNG, MARY C (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-5711
Mailing Address - Country:US
Mailing Address - Phone:361-727-0143
Mailing Address - Fax:361-727-2036
Practice Address - Street 1:2806 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5711
Practice Address - Country:US
Practice Address - Phone:361-727-0143
Practice Address - Fax:361-727-2036
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2887010Medicaid