Healthcare Provider Details

I. General information

NPI: 1053304790
Provider Name (Legal Business Name): JAMES A YOUNG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 9 BOX 4127
APO AE
09123
DE

IV. Provider business mailing address

PSC 9 BOX 4127
APO AE
09123
DE

V. Phone/Fax

Practice location:
  • Phone: 4-965-6551
  • Fax: 8280
Mailing address:
  • Phone: 4-965-6551
  • Fax: 8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01-4P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: