Healthcare Provider Details

I. General information

NPI: 1619696770
Provider Name (Legal Business Name): SUSAN L YOUNG-MARKEY CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN L YOUNG-MARKEY CTRS

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH HIGHWAY 89 CLC BUILDING 148 ROOM A105
PRESCOTT AZ
86313
US

IV. Provider business mailing address

500 NORTH HIGHWAY 89 CLC BUILDING 148 ROOM A105
PRESCOTT AZ
86313
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax:
Mailing address:
  • Phone: 928-445-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number23258
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: