Provider Demographics
NPI:1639540032
Name:YOUNG, SAMUEL III
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 NE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7501
Mailing Address - Country:US
Mailing Address - Phone:405-476-8412
Mailing Address - Fax:
Practice Address - Street 1:641 NE 33RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7501
Practice Address - Country:US
Practice Address - Phone:405-476-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health