Provider Demographics
NPI:1336385897
Name:YOUNG, COLLEEN ANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:QUITSLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:9 ST. HELEN'S AVE
Mailing Address - Street 2:STE C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-576-7896
Mailing Address - Fax:866-579-4088
Practice Address - Street 1:2622 MCCARVER ST.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403
Practice Address - Country:US
Practice Address - Phone:253-576-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60044983101Y00000X
WALF 60258087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor