Provider Demographics
NPI:1821667411
Name:YOUNGBLOOD, MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GULF FWY S STE 110
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5148
Mailing Address - Country:US
Mailing Address - Phone:281-316-6006
Mailing Address - Fax:281-346-9958
Practice Address - Street 1:1100 GULF FWY S STE 110
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5148
Practice Address - Country:US
Practice Address - Phone:281-316-6006
Practice Address - Fax:281-346-9958
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1102XOther Service ProvidersSpecialistResearch Study