Provider Demographics
NPI:1265494967
Name:YOUNG, LAMAR L (PHD)
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:L
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 1:1403 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3406
Mailing Address - Country:US
Mailing Address - Phone:704-482-1447
Mailing Address - Fax:704-481-9744
Practice Address - Street 1:1403 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:704-482-1447
Practice Address - Fax:704-481-9744
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1315231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R40627Medicare UPIN
NC252006Medicare ID - Type Unspecified