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NPI Code Detail

MEDICARE: MR. BOBBY GLYNN YOUNG LMFT

MEDICARE: MR. BOBBY GLYNN YOUNG LMFT
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
1106H00000XMarriage & Family Therapist170OK

General Provider Information

NPI Number : 1952631954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BOBBY GLYNN YOUNG LMFT
Provider Business Mailing Address
First Line : 1516 S BOSTON AVE
Second Line : SUITE 100
City : TULSA
State : OK
Zip : 74119-4003
Country : US
Telephone Number : 916-561-6000
Fax Number : 918-561-6001
Provider Business Practice Location Address
First Line : 1516 S BOSTON AVE
Second Line : SUITE 100
City : TULSA
State : OK
Zip : 74119-4003
Country : US
Telephone Number : 916-561-6000
Fax Number : 918-561-6001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2010
Last Update Date : 01/13/2010

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