MEDICARE: TAMI LORRAINE YOUNG PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4776	AZ

General Provider Information

NPI Number	:	1043390479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI LORRAINE YOUNG PHD

Provider Business Mailing Address
First Line	:	421 N HUMPHREYS ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-4531
Country	:	US
Telephone Number	:	928-482-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 N HUMPHREYS ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-4531
Country	:	US
Telephone Number	:	928-482-2323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/03/2017

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