MEDICARE: MS. BEVERLY ANN YOUNG L.P.C.

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	12232	TX

General Provider Information

NPI Number	:	1427180710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ANN YOUNG L.P.C.

Provider Business Mailing Address
First Line	:	1920 ABRAMS PKWY
Second Line	:	#394
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	214-537-8455
Fax Number	:	214-823-1134

Provider Business Practice Location Address
First Line	:	6162 E MOCKINGBIRD LN
Second Line	:	SUITE 204
City	:	DALLAS
State	:	TX
Zip	:	75214-2697
Country	:	US
Telephone Number	:	214-537-8455
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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