Healthcare Provider Details

I. General information

NPI: 1134220247
Provider Name (Legal Business Name): WILLIAM BERNARD YOUNG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 N GLASSELL ST
ORANGE CA
92867-6748
US

IV. Provider business mailing address

341 E OAKMONT AVE
ORANGE CA
92867-6829
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-7247
  • Fax: 714-633-7224
Mailing address:
  • Phone: 714-628-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY9978
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY9978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: