Provider Demographics
NPI:1619556123
Name:ANCHOR TO SERENITY LLC
Entity Type:Organization
Organization Name:ANCHOR TO SERENITY LLC
Other - Org Name:TERRY L. YOUNG MS LPC, LCDC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:YOUNG MS LPC
Authorized Official - Last Name:LCDC
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:512-429-4334
Mailing Address - Street 1:1524 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2607
Mailing Address - Country:US
Mailing Address - Phone:512-429-8206
Mailing Address - Fax:
Practice Address - Street 1:1524 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2607
Practice Address - Country:US
Practice Address - Phone:512-429-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394109801Medicaid