Healthcare Provider Details

I. General information

NPI: 1518675164
Provider Name (Legal Business Name): SHELBY MARIE YOUNG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 W SACK DR STE 220
GLENDALE AZ
85308-7549
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0414
  • Fax: 602-933-4252
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22967
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: