MEDICARE: DR. CANDACE A YOUNG PH.D.

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	103T00000X	Psychologist	PSY14064	CA
2	106H00000X	Marriage & Family Therapist	MFC24723	CA

General Provider Information

NPI Number	:	1831307131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDACE A YOUNG PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 633
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91043-0633
Country	:	US
Telephone Number	:	818-353-3460
Fax Number	:	818-353-3460

Provider Business Practice Location Address
First Line	:	3795 LA CRESCENTA AVE
Second Line	:	100
City	:	GLENDALE
State	:	CA
Zip	:	91208-1057
Country	:	US
Telephone Number	:	818-353-3460
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/18/2007

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