Provider Demographics
NPI:1073669982
Name:YOUNG, DELTON W (PHD)
Entity Type:Individual
Prefix:
First Name:DELTON
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 112TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2943
Mailing Address - Country:US
Mailing Address - Phone:425-462-9511
Mailing Address - Fax:425-462-8894
Practice Address - Street 1:2025 112TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2943
Practice Address - Country:US
Practice Address - Phone:425-462-9511
Practice Address - Fax:425-462-8894
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPY00001580103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic