Provider Demographics
NPI:1821360249
Name:YORK, MICHAEL BRENT (LCAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRENT
Last Name:YORK
Suffix:
Gender:M
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3868
Mailing Address - Country:US
Mailing Address - Phone:502-727-1038
Mailing Address - Fax:
Practice Address - Street 1:214 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 214
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3868
Practice Address - Country:US
Practice Address - Phone:502-727-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000141A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical