Provider Demographics
NPI:1558074484
Name:YOUNG, RHEA (LAC)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8865 E BASELINE RD # 450
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5300
Mailing Address - Country:US
Mailing Address - Phone:303-596-1156
Mailing Address - Fax:
Practice Address - Street 1:3512 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-9713
Practice Address - Country:US
Practice Address - Phone:602-449-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional