Provider Demographics
NPI:1801226766
Name:YOUNG, COURTNEY GROVES
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GROVES
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19700 S VERMONT AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1100
Mailing Address - Country:US
Mailing Address - Phone:213-252-5800
Mailing Address - Fax:310-329-3611
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:STE 250
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:213-252-5800
Practice Address - Fax:310-329-3611
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist