Provider Demographics
NPI:1972657765
Name:YOUNG, MARK E (PSYD, BCPC, CCBT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PSYD, BCPC, CCBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W HENDRICKS ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1923
Mailing Address - Country:US
Mailing Address - Phone:972-291-7260
Mailing Address - Fax:
Practice Address - Street 1:408 W AVENUE F
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2963
Practice Address - Country:US
Practice Address - Phone:972-723-0044
Practice Address - Fax:972-775-2002
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health