Provider Demographics
NPI:1033217815
Name:YOUNG, WILLIAM R (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W DUBOIS AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3000
Mailing Address - Country:US
Mailing Address - Phone:814-371-0794
Mailing Address - Fax:814-371-6733
Practice Address - Street 1:150 W DUBOIS AVE
Practice Address - Street 2:SUITE H
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3000
Practice Address - Country:US
Practice Address - Phone:814-371-0794
Practice Address - Fax:814-371-6733
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003513L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
348937OtherBCBS
PA603171OtherBCBS