Provider Demographics
NPI:1720208143
Name:YOUNG, KAREN M (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E. MISSION RD., #16
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-282-0358
Mailing Address - Fax:
Practice Address - Street 1:1447 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:626-377-2272
Practice Address - Fax:626-270-4164
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACBSC588OtherLA DMH PROVIDER
CA00007302Medicaid