Basic Information
| Provider Information | |||||||||
| NPI: | 1922026137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | HENRY | ||||||||
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| Credential: | MSW,LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13486 CRESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493311110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168972574 | ||||||||
| FaxNumber: | 6168972574 | ||||||||
| Practice Location | |||||||||
| Address1: | 3019 COIT AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495053376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163659575 | ||||||||
| FaxNumber: | 6163659480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801083452 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.