Healthcare Provider Details

I. General information

NPI: 1780187401
Provider Name (Legal Business Name): MR. TRAVIS D. YOUNG II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W LANCASTER AVE
DEVON PA
19333-1560
US

IV. Provider business mailing address

235 W LANCASTER AVE
DEVON PA
19333-1560
US

V. Phone/Fax

Practice location:
  • Phone: 443-279-7396
  • Fax: 410-878-1962
Mailing address:
  • Phone: 484-551-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2058
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0710103129
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: