Provider Demographics
NPI:1073665139
Name:YOUNG, DAVID ROGER (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROGER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S LAKESHORE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7155
Mailing Address - Country:US
Mailing Address - Phone:480-345-7755
Mailing Address - Fax:480-345-8833
Practice Address - Street 1:4801 S LAKESHORE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7155
Practice Address - Country:US
Practice Address - Phone:480-345-7755
Practice Address - Fax:480-345-8833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1035103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist