Provider Demographics
NPI:1578586335
Name:YOUNG, JAMIE ELLE (LPC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BALMAIN CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5097
Mailing Address - Country:US
Mailing Address - Phone:682-710-1107
Mailing Address - Fax:
Practice Address - Street 1:185 S WHITE CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7308
Practice Address - Country:US
Practice Address - Phone:682-710-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional