Provider Demographics
NPI:1962526517
Name:YOUNGBLOOD, KEITH A (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:7331 CLAIRBORNE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-7119
Mailing Address - Country:US
Mailing Address - Phone:907-301-2992
Mailing Address - Fax:907-222-5254
Practice Address - Street 1:7331 CLAIRBORNE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-7119
Practice Address - Country:US
Practice Address - Phone:907-301-2992
Practice Address - Fax:907-222-5254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK461103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist