Provider Demographics
NPI:1891174561
Name:YOUNG, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5282
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-0282
Mailing Address - Country:US
Mailing Address - Phone:626-625-6646
Mailing Address - Fax:626-202-1273
Practice Address - Street 1:153 E WHITTIER BLVD
Practice Address - Street 2:#C
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3883
Practice Address - Country:US
Practice Address - Phone:626-625-6646
Practice Address - Fax:626-202-1273
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical