Provider Demographics
NPI:1740593201
Name:YOUNG, MICHELLE MARIE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:FLICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2501 HANLEY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016
Mailing Address - Country:US
Mailing Address - Phone:715-381-1980
Mailing Address - Fax:715-381-1906
Practice Address - Street 1:1107 HAZELTINE BLVD STE 470
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1066
Practice Address - Country:US
Practice Address - Phone:763-249-5031
Practice Address - Fax:888-821-5733
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI810-226101YP2500X
WI4848-125101YP2500X
MN2524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4848125OtherLICENSED PROFESSIONAL COUNSELOR - WISCONSIN D.S.P.S.
WI1740593201Medicaid
MN2524OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR (LPCC) - MN BBHT
12407924OtherCAQH
WI6272920OtherAMERICAN COUNSELING ASSOCIATION PROFESSIONAL MEMBER