Healthcare Provider Details

I. General information

NPI: 1568983997
Provider Name (Legal Business Name): BENJAMIN M YOUNG LMHC, MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 NE FERN ST
SUQUAMISH WA
98392-9539
US

IV. Provider business mailing address

PO BOX 165
SUQUAMISH WA
98392-0165
US

V. Phone/Fax

Practice location:
  • Phone: 425-248-1010
  • Fax:
Mailing address:
  • Phone: 425-248-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60761069
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60869790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: