Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS-005923-L | PA |
Y | 103T00000X | Psychologist | PS-005923-L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3809 | NC |
NPI | 1083754691 |
---|---|
Provider Name | Mr. Michael Robert Youron |
First Address | Huntersville, NC 28078-6820 |
Second Address | Huntersville, NC 28078-6820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 19/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078668 | FIRST PRIORITY HEALTH HMO (01) | PA |
667768 | HIGHMARK BC/BS (01) | PA |
7869127 | AETNA (01) | PA |