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General NPI Number Information
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NPI Number | 1134773328
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Entity Type | Individual
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Provider Name | DWAIN KEITH YOUNG LPC
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Gender | Male
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 10100 N CENTRAL EXPY STE 240
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City | DALLAS
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State | TX
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Zip | 75231-4113
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Country | US
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Telephone | 214-448-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 TRINITY ST
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City | IRVING
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State | TX
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Zip | 75062-5234
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Country | US
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Telephone | 214-529-4115
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 77722
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License Number State | TX
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