Provider Demographics
NPI:1962642025
Name:YOUNG, MICHAEL TERRY (MSTCM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TERRY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036
Mailing Address - Country:US
Mailing Address - Phone:413-348-9228
Mailing Address - Fax:
Practice Address - Street 1:319 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036
Practice Address - Country:US
Practice Address - Phone:413-348-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist