Provider Demographics
NPI:1053407742
Name:YOUNG, KATHERINE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:MCCONKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA PHD
Mailing Address - Street 1:1943 WINDSIDE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:248-681-5829
Mailing Address - Fax:
Practice Address - Street 1:1943 WINDSIDE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324
Practice Address - Country:US
Practice Address - Phone:248-681-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620F34753Medicare ID - Type Unspecified