Provider Demographics
NPI:1821422155
Name:YOUNG, SANDRA ANN
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANN
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 1:2001 LAWRY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3558
Mailing Address - Country:US
Mailing Address - Phone:702-487-3257
Mailing Address - Fax:
Practice Address - Street 1:1100 N MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2853
Practice Address - Country:US
Practice Address - Phone:702-810-4830
Practice Address - Fax:702-255-7766
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst