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NPI Code Detail

MEDICARE: DERICKA LEA YOUNG MS, LPC

MEDICARE: DERICKA LEA YOUNG MS, LPC
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
1101YP2500XProfessional Counselor77911TX
2101YM0800XMental Health Counselor77911TX
3101Y00000XCounselor77911TX

General Provider Information

NPI Number : 1659831600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERICKA LEA YOUNG MS, LPC
Provider Business Mailing Address
First Line : 5900 BALCONES DR # 19525
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4257
Country : US
Telephone Number : 682-258-9740
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLZ DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 682-258-9740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2019
Last Update Date : 09/27/2025

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