Provider Demographics
NPI:1114050853
Name:YOUNG, LINDA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:RAE
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 37067
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32315-7067
Mailing Address - Country:US
Mailing Address - Phone:850-656-1404
Mailing Address - Fax:850-222-1484
Practice Address - Street 1:219 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6205
Practice Address - Country:US
Practice Address - Phone:850-656-1404
Practice Address - Fax:850-222-1484
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist