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General NPI Number Information
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NPI Number | 1356261788
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Entity Type | Organization
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Legal Business Name | YOUNG HEADWATERS
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 224 W DRYDEN ST APT 209
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City | GLENDALE
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State | CA
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Zip | 91202-3739
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Country | US
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Telephone | 818-208-1774
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Fax |
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Provider Business Mailing Address
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Address Line | 213 N GLENDALE AVE # 1024
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City | GLENDALE
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State | CA
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Zip | 91206-4455
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Country | US
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Telephone | 818-208-1774
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANN M YOUNG
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Credential |
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Telephone | 818-208-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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