MEDICARE: MICHAEL YOUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		ND

General Provider Information

NPI Number	:	1023859683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL YOUNG

Provider Business Mailing Address
First Line	:	3435 5TH ST W APT 301
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8173
Country	:	US
Telephone Number	:	701-405-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 5TH ST W APT 301
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8173
Country	:	US
Telephone Number	:	701-405-6899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/15/2024

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Directions to “ MICHAEL YOUNG ” Practice Location

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