Provider Demographics
NPI:1952631954
Name:YOUNG, BOBBY GLYNN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:GLYNN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 S BOSTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4003
Mailing Address - Country:US
Mailing Address - Phone:916-561-6000
Mailing Address - Fax:918-561-6001
Practice Address - Street 1:1516 S BOSTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:916-561-6000
Practice Address - Fax:918-561-6001
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist