Provider Demographics
NPI:1598076150
Name:YOUNG, SUSAN B (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
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 1:530 W UNION ST STE D
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8303
Mailing Address - Country:US
Mailing Address - Phone:740-249-4159
Mailing Address - Fax:740-249-4296
Practice Address - Street 1:530 W UNION ST
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8303
Practice Address - Country:US
Practice Address - Phone:740-249-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5596103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist