Provider Demographics
NPI:1225478274
Name:YOUNG, KATHLEEN GAZAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:GAZAM
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 1:1920 DOVE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2953
Mailing Address - Country:US
Mailing Address - Phone:405-329-8590
Mailing Address - Fax:
Practice Address - Street 1:1920 DOVE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2953
Practice Address - Country:US
Practice Address - Phone:405-329-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0000000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health