Basic Information
| Provider Information | |||||||||
| NPI: | 1851436885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | LELIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, LMSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 AMBER PASS | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787453784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128250975 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 515 S. CAPITAL OF TEXAS HWY | ||||||||
| Address2: | SUITE # 230 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787464314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123287222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 35384 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.