1417626748 NPI number — MI JUNG YOU LMHC

Table of content: MI JUNG YOU LMHC (NPI 1417626748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417626748 NPI number — MI JUNG YOU LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOU
Provider First Name:
MI JUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417626748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11611 CURZON RD APT 6A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11418-3496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-497-4024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4332 22ND ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-497-4024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  004834-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15812852400 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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