Provider Demographics
NPI:1891086997
Name:YOUNG, CALLIE COMMERLEATHY (PHD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:COMMERLEATHY
Last Name:YOUNG
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 1:622 JANISCH RD TRLR 4A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-2263
Mailing Address - Country:US
Mailing Address - Phone:832-537-2299
Mailing Address - Fax:
Practice Address - Street 1:622 JANISCH RD TRLR 4A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-2263
Practice Address - Country:US
Practice Address - Phone:832-537-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service