Provider Demographics
NPI:1831307131
Name:YOUNG, CANDACE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91043-0633
Mailing Address - Country:US
Mailing Address - Phone:818-353-3460
Mailing Address - Fax:818-353-3460
Practice Address - Street 1:3795 LA CRESCENTA AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1057
Practice Address - Country:US
Practice Address - Phone:818-353-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14064103T00000X
CAMFC24723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist