Individual provider Active NPI

Lincoya Danese Young, LICENSED PROFESSIONA

  • Professional Counselor
  • Grand Prairie, TX
National Provider Identifier
1700055118
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
58413 Issued in TX
Practice address
509 NE 4TH St
#200
Grand Prairie, TX 75050-5738
Phone
(972) 264-0604
Fax
(972) 264-9998
NPI assigned
Feb 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 58413 TX Primary

Addresses

Primary practice location

509 NE 4TH St
#200
Grand Prairie, TX 75050-5738

Mailing address

509 NE 4TH St
#200
Grand Prairie, TX 75050-5738
Phone (972) 264-0604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA, OR3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20240516000640 TX Practitioner - Mental Health Counselor 5496196859 Reassigns benefits to 1 organization
I20240522003088 CA Practitioner - Mental Health Counselor 5496196859 Reassigns benefits to 2 organizations
I20241017000390 OR Practitioner - Mental Health Counselor 5496196859 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2972CAMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Professional CurrentSince Apr 10, 2024 Accepting new patients
Cyti Health PC CurrentSince Jun 14, 2024 Accepting new patients
Grow Healthcare Group PA Professional CurrentSince Apr 10, 2024 Accepting new patients
Children First, Inc. Past Accepting new patients

Locations

11801 Pierce St
Riverside, CA 92505
Phone (909) 528-0317

3111 Camino del Rio N
Ste 460
San Diego, CA 92108

402 W Broadway
Ste 400
San Diego, CA 92101
Phone (619) 810-1939

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

10260 SW Greenburg Rd
Fl 4
Tigard, OR 97223
Phone (503) 405-9338

700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1700055118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 NE 4TH ST",
            "address_2": "#200",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750505738",
            "telephone_number": "972-264-0604",
            "fax_number": "972-264-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 NE 4TH ST",
            "address_2": "#200",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750505738",
            "telephone_number": "972-264-0604",
            "fax_number": "972-264-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "LINCOYA",
        "middle_name": "DANESE",
        "credential": "LICENSED PROFESSIONA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-29",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "58413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.