Healthcare Provider Details

I. General information

NPI: 1083914451
Provider Name (Legal Business Name): MR. ALAN LEROY YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W LANCASTER BLVD
LANCASTER CA
93534-2305
US

IV. Provider business mailing address

1301 E AVENUE I SP. # 07
LANCASTER CA
93535-2149
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax:
Mailing address:
  • Phone: 661-733-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCALCR1-1805-121211A
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: