Provider Demographics
NPI:1114231594
Name:YOUNG, FELICITY PEARL (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:FELICITY
Middle Name:PEARL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEWLLANO
Mailing Address - State:LA
Mailing Address - Zip Code:71461-9739
Mailing Address - Country:US
Mailing Address - Phone:541-633-8019
Mailing Address - Fax:
Practice Address - Street 1:601 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:NEWLLANO
Practice Address - State:LA
Practice Address - Zip Code:71461-9739
Practice Address - Country:US
Practice Address - Phone:541-633-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst