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General NPI Number Information
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NPI Number | 1952752271
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Entity Type | Organization
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Legal Business Name | YOUNGS THERAPY
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 6200 STONERIDGE MALL RD 303
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City | PLEASANTON
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State | CA
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Zip | 94588-3242
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Country | US
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Telephone | 925-399-6147
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Fax | 925-399-6149
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Provider Business Mailing Address
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Address Line | 6200 STONERIDGE MALL RD 303
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City | PLEASANTON
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State | CA
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Zip | 94588-3242
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Country | US
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Telephone | 925-399-6147
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Fax | 925-399-6149
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLARENCE YOUNGS
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Credential | LMFT
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Telephone | 925-399-6147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LMFT51775
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License Number State | CA
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