Provider Demographics
NPI:1992006431
Name:YOUNG, TANYA Y (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:Y
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:Y
Other - Last Name:GREAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSC-AD
Mailing Address - Street 1:6066 SHINGLE CREEK PKWY # 172
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2316
Mailing Address - Country:US
Mailing Address - Phone:763-220-4971
Mailing Address - Fax:
Practice Address - Street 1:6066 SHINGLE CREEK PKWY # 172
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2316
Practice Address - Country:US
Practice Address - Phone:763-220-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC0649101YP2500X
MNCC00649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional