Healthcare Provider Details

I. General information

NPI: 1659050383
Provider Name (Legal Business Name): SASCHA SIMONE YOUNG EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5783 LOWRY RD
MEMPHIS TN
38115-5001
US

IV. Provider business mailing address

5783 LOWRY RD
MEMPHIS TN
38115-5001
US

V. Phone/Fax

Practice location:
  • Phone: 901-428-5983
  • Fax:
Mailing address:
  • Phone: 901-428-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number000733473
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: