Healthcare Provider Details

I. General information

NPI: 1235070764
Provider Name (Legal Business Name): MICHAEL SHANE YOUNG CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S 300 W
BICKNELL UT
84715-7722
US

IV. Provider business mailing address

PO BOX 303
BICKNELL UT
84715-0303
US

V. Phone/Fax

Practice location:
  • Phone: 435-425-3744
  • Fax:
Mailing address:
  • Phone: 435-425-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14275660-6004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number14275660-6004
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14275660-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: