Provider Demographics
NPI:1225324163
Name:YOUNG, JOHN
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:101 RICKY D BRITT SR BLVD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9103
Mailing Address - Country:US
Mailing Address - Phone:662-380-5031
Mailing Address - Fax:
Practice Address - Street 1:101 RICKY D BRITT SR BLVD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9103
Practice Address - Country:US
Practice Address - Phone:662-380-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS50-882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical