Healthcare Provider Details

I. General information

NPI: 1023552254
Provider Name (Legal Business Name): RAVEN JOLEEN YOUNG PMHNP-BC, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 6TH AVE STE 100
TACOMA WA
98405-3300
US

IV. Provider business mailing address

1712 6TH AVE
TACOMA WA
98405-3300
US

V. Phone/Fax

Practice location:
  • Phone: 253-666-9974
  • Fax:
Mailing address:
  • Phone: 253-666-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60153496
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number807632
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61351553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: