MEDICARE: WILLIAM BERNARD 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	103TP0814X	Psychoanalysis Psychologist	PSY9978	CA
2	103TP2701X	Group Psychotherapy Psychologist	PSY9978	CA
3	103TC0700X	Clinical Psychologist	PSY9978	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00PL99780	OTHER	CA	BLUE SHIELD
2	PSY099780	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1134220247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BERNARD YOUNG PHD

Provider Business Mailing Address
First Line	:	341 E OAKMONT AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-6829
Country	:	US
Telephone Number	:	714-628-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	594 N GLASSELL ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-6748
Country	:	US
Telephone Number	:	714-633-7247
Fax Number	:	714-633-7224

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	01/28/2021

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