Provider Demographics
NPI:1578528832
Name:YOUNG, WALTER C (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N. SPRUCE ST.
Mailing Address - Street 2:
Mailing Address - City:COPLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-1436
Mailing Address - Country:US
Mailing Address - Phone:719-327-5697
Mailing Address - Fax:719-633-8741
Practice Address - Street 1:25 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1436
Practice Address - Country:US
Practice Address - Phone:719-327-5697
Practice Address - Fax:719-633-8741
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health