Provider Demographics
NPI:1922262773
Name:YOUNG, FRANK CHARLEY (MED, LISAC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:CHARLEY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MED, LISAC
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 1295
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-1295
Mailing Address - Country:US
Mailing Address - Phone:928-645-1216
Mailing Address - Fax:928-645-4079
Practice Address - Street 1:337 NORTH NAVAJO DRIVE
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-645-1216
Practice Address - Fax:928-645-4079
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)