Provider Demographics
NPI:1023539525
Name:YOUNG, AMBER MORSE (MED BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MORSE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 N WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3490
Mailing Address - Country:US
Mailing Address - Phone:208-283-6175
Mailing Address - Fax:
Practice Address - Street 1:4232 N WATERFORD PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3490
Practice Address - Country:US
Practice Address - Phone:208-283-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-17-28169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0003129Medicaid