Healthcare Provider Details

I. General information

NPI: 1235627043
Provider Name (Legal Business Name): VALERIE YOUNG LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 KALAMAZOO AVE SE
GRAND RAPIDS MI
49507-3780
US

IV. Provider business mailing address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-8390
  • Fax:
Mailing address:
  • Phone: 616-965-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015979
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: