Provider Demographics
NPI:1326271925
Name:YOUNG, JUDITH LUCILLE (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LUCILLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LUCILLE
Other - Last Name:AUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43051 COUNTRY CLUB DR W
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9607
Mailing Address - Country:US
Mailing Address - Phone:949-275-2019
Mailing Address - Fax:559-658-6209
Practice Address - Street 1:43051 COUNTRY CLUB DR W
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9607
Practice Address - Country:US
Practice Address - Phone:949-275-2019
Practice Address - Fax:559-658-6209
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist