MEDICARE: AYESHA YOUNGBLOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	91134	TX
2	101YM0800X	Mental Health Counselor	91134	TX

General Provider Information

NPI Number	:	1235839630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA YOUNGBLOOD

Provider Business Mailing Address
First Line	:	19939 LONGENBAUGH RD # 428
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-8751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19939 LONGENBAUGH RD # 428
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-8751
Country	:	US
Telephone Number	:	443-726-1647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	04/03/2026

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Directions to “ AYESHA YOUNGBLOOD ” Practice Location

Language	Start Address	Practice Location

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