Provider Demographics
NPI:1770036261
Name:YOUNG, HEATHER CALDWELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CALDWELL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 E PINCHOT AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7215
Mailing Address - Country:US
Mailing Address - Phone:602-777-3585
Mailing Address - Fax:
Practice Address - Street 1:4207 E PINCHOT AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7215
Practice Address - Country:US
Practice Address - Phone:602-777-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZ005294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health