1053304790 NPI number — DR. JAMES A YOUNG PHD

Table of content: CHRISTINA NORTHERN NORTHERHN (NPI 1861736373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053304790 NPI number — DR. JAMES A YOUNG PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053304790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 9 BOX 4127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09123
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
4-965-6551
Provider Business Mailing Address Fax Number:
8280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 9 BOX 4127
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09123
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
4-965-6551
Provider Business Practice Location Address Fax Number:
8280
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  01-4P , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-4P . This is a "PSYCHOLOGIST" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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