Provider Demographics
NPI:1700055118
Name:YOUNG, LINCOYA PANESE (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:
First Name:LINCOYA
Middle Name:PANESE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 NE 4TH ST
Mailing Address - Street 2:#200
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5738
Mailing Address - Country:US
Mailing Address - Phone:972-264-0604
Mailing Address - Fax:972-264-9998
Practice Address - Street 1:509 NE 4TH ST
Practice Address - Street 2:#200
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5738
Practice Address - Country:US
Practice Address - Phone:972-264-0604
Practice Address - Fax:972-264-9998
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional