Provider Demographics
NPI:1033664214
Name:YOUNG, JAMES J
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
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 1:7415 GATEHOUSE CIR APT 180
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-6011
Mailing Address - Country:US
Mailing Address - Phone:407-314-0383
Mailing Address - Fax:407-964-3238
Practice Address - Street 1:7415 GATEHOUSE CIR APT 180
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-6011
Practice Address - Country:US
Practice Address - Phone:407-314-0383
Practice Address - Fax:407-964-3238
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician