Provider Demographics
NPI:1760685036
Name:YOUNG, TED W (PHD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3825 SQUAW VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5663
Mailing Address - Country:US
Mailing Address - Phone:775-826-1244
Mailing Address - Fax:775-826-5139
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:STE 52
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6102
Practice Address - Country:US
Practice Address - Phone:775-826-1244
Practice Address - Fax:775-826-7751
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVNV120103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist