Provider Demographics
NPI:1669939708
Name:YOUNG, TERRY L (LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 FM 3061
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76577
Mailing Address - Country:US
Mailing Address - Phone:512-446-2282
Mailing Address - Fax:
Practice Address - Street 1:3632 FM 3061
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:TX
Practice Address - Zip Code:76577-8537
Practice Address - Country:US
Practice Address - Phone:512-365-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12704101YA0400X
TX77597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)