Provider Demographics
NPI:1770842106
Name:YOUNG, BRADLEY (APC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 W 5075 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-7703
Mailing Address - Country:US
Mailing Address - Phone:801-499-7096
Mailing Address - Fax:
Practice Address - Street 1:3871 W 5075 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-7703
Practice Address - Country:US
Practice Address - Phone:801-499-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5994045-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health