Provider Demographics
NPI:1093558264
Name:YOUNG, RYAN ISRAEL (LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ISRAEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 N DELAWARE ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3847
Mailing Address - Country:US
Mailing Address - Phone:480-433-5354
Mailing Address - Fax:
Practice Address - Street 1:4657 S LAKESHORE DR STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7170
Practice Address - Country:US
Practice Address - Phone:480-718-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-223461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical