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General NPI Number Information
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NPI Number | 1093073702
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Entity Type | Individual
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Provider Name | MARY E YOUNG MA, LMFT, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | LIFEWORKS COUNSELING SERVICES 2500 S BROADWAY, STE 340B
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-792-0229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5721
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City | EDMOND
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State | OK
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Zip | 73083-5721
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Country | US
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Telephone | 405-792-0229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1151LMFT
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6297LPC
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License Number State | OK
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