Provider Demographics
NPI:1134773328
Name:YOUNG, DWAIN KEITH (LPC)
Entity type:Individual
Prefix:MR
First Name:DWAIN
Middle Name:KEITH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5234
Mailing Address - Country:US
Mailing Address - Phone:214-529-4115
Mailing Address - Fax:
Practice Address - Street 1:10100 N CENTRAL EXPY STE 240
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4113
Practice Address - Country:US
Practice Address - Phone:214-448-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional