Provider Demographics
NPI:1013385244
Name:YOUNG, BENJAMIN (CMHC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W 900 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6759
Mailing Address - Country:US
Mailing Address - Phone:801-472-2687
Mailing Address - Fax:
Practice Address - Street 1:704 N STATE ROAD 51
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1385
Practice Address - Country:US
Practice Address - Phone:801-787-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11469253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency