Provider Demographics
NPI:1396628640
Name:YOUNGER, REGINALD JR (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:YOUNGER
Suffix:JR
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 E DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7343
Mailing Address - Country:US
Mailing Address - Phone:480-282-2497
Mailing Address - Fax:
Practice Address - Street 1:700 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2201
Practice Address - Country:US
Practice Address - Phone:602-616-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician