Provider Demographics
NPI:1891880522
Name:YOUNG, KENT ALAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PH D
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 1810
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061
Mailing Address - Country:US
Mailing Address - Phone:440-255-0333
Mailing Address - Fax:440-255-0333
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-255-0333
Practice Address - Fax:440-255-0333
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
YQCP00561Medicare ID - Type Unspecified