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General NPI Number Information
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NPI Number | 1578586335
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Entity Type | Individual
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Provider Name | JAMIE ELLE YOUNG LPC, RPT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 185 S WHITE CHAPEL BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7308
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Country | US
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Telephone | 682-710-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 2542 BALMAIN CT
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City | TROPHY CLUB
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State | TX
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Zip | 76262-5097
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Country | US
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Telephone | 682-710-1107
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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 | 18233
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License Number State | TX
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