Provider Demographics
NPI:1689302176
Name:YOUNG, COREY MARSETT (SC61292982)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MARSETT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:SC61292982
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 64082
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98464-0082
Mailing Address - Country:US
Mailing Address - Phone:253-651-0649
Mailing Address - Fax:
Practice Address - Street 1:5900 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2749
Practice Address - Country:US
Practice Address - Phone:253-651-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61292982101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor