Provider Demographics
NPI:1730286253
Name:YOUNG, LUCHIA (PMHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LUCHIA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18247 N TOYA ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2905
Mailing Address - Country:US
Mailing Address - Phone:832-964-4022
Mailing Address - Fax:347-960-4805
Practice Address - Street 1:18247 N TOYA ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2905
Practice Address - Country:US
Practice Address - Phone:832-964-4022
Practice Address - Fax:347-960-4805
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5602363LP0808X
AZAP3446363LF0000X, 363LP0808X
NMCNP00749363LF0000X
TX609961363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ169721OtherMEDICARE
AZ459804Medicaid