Provider Demographics
NPI:1134337884
Name:MENDENHALL, MARILYN YOUNG (LMHC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:YOUNG
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:LEE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-0546
Mailing Address - Country:US
Mailing Address - Phone:845-350-1040
Mailing Address - Fax:
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:SUITE # 7
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health