Provider Demographics
NPI:1487914222
Name:YOUNG, JOSHUA ADAM
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ADAM
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 WYNN DR
Mailing Address - Street 2:APT 64
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4641
Mailing Address - Country:US
Mailing Address - Phone:580-917-8712
Mailing Address - Fax:
Practice Address - Street 1:3621 WYNN DR
Practice Address - Street 2:APT 64
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4641
Practice Address - Country:US
Practice Address - Phone:580-917-8712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK082023562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst