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NPI Code Detail

MEDICARE: DELISA YOUNG

MEDICARE: DELISA YOUNG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1245783562
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELISA YOUNG
Provider Business Mailing Address
First Line : 3517 NW 164TH TER
Second Line :
City : EDMOND
State : OK
Zip : 73013-9471
Country : US
Telephone Number : 405-605-2663
Fax Number :
Provider Business Practice Location Address
First Line : 2248 NW 164TH ST
Second Line :
City : EDMOND
State : OK
Zip : 73013-8801
Country : US
Telephone Number : 405-605-2663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2016
Last Update Date : 05/28/2021

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Directions to “ DELISA YOUNG ” Practice Location

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