Provider Demographics
NPI:1417602046
Name:YOUNG, HAROLD WAYNE II (PMHNP-NP)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:WAYNE
Last Name:YOUNG
Suffix:II
Gender:M
Credentials:PMHNP-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4074 1/2 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-6032
Mailing Address - Country:US
Mailing Address - Phone:865-258-0161
Mailing Address - Fax:
Practice Address - Street 1:4074 1/2 TEXAS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-6032
Practice Address - Country:US
Practice Address - Phone:865-258-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019914363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health