Provider Demographics
NPI:1679612394
Name:YOUNG, DOUGLAS BRUCE (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BRUCE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:18040 SHERMAN WAY
Mailing Address - Street 2:DEPARTMENT OF BEHAVIORAL HEALTH
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4631
Mailing Address - Country:US
Mailing Address - Phone:818-758-1244
Mailing Address - Fax:818-758-1366
Practice Address - Street 1:18040 SHERMAN WAY
Practice Address - Street 2:DEPARTMENT OF BEHAVIORAL HEALTH
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4631
Practice Address - Country:US
Practice Address - Phone:818-758-1244
Practice Address - Fax:818-758-1366
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY7862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical