Provider Demographics
NPI:1053304790
Name:YOUNG, JAMES A (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 9 BOX 4127
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123
Mailing Address - Country:DE
Mailing Address - Phone:004-965-6551
Mailing Address - Fax:8280
Practice Address - Street 1:PSC 9 BOX 4127
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09123
Practice Address - Country:DE
Practice Address - Phone:004-965-6551
Practice Address - Fax:8280
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR01-4P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR01-4POtherPSYCHOLOGIST