Healthcare Provider Details

I. General information

NPI: 1962316844
Provider Name (Legal Business Name): CARL EDWARD YOUNG JR. LPC MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 SUNDALE WAY W
MEMPHIS TN
38135-4211
US

IV. Provider business mailing address

3911 SUNDALE WAY W
MEMPHIS TN
38135-4211
US

V. Phone/Fax

Practice location:
  • Phone: 901-550-4075
  • Fax:
Mailing address:
  • Phone: 901-550-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7980
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: