Provider Demographics
NPI:1245853050
Name:YOUNG, MICHELE DENISE (MS, LPP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DENISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 FOUR MILE PKWY
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9114
Mailing Address - Country:US
Mailing Address - Phone:719-276-7500
Mailing Address - Fax:
Practice Address - Street 1:700 FOUR MILE PKWY
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9114
Practice Address - Country:US
Practice Address - Phone:719-276-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health