Provider Demographics
NPI:1245701572
Name:YOUNG, ALLIYAH (RBT)
Entity type:Individual
Prefix:
First Name:ALLIYAH
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6367
Mailing Address - Country:US
Mailing Address - Phone:682-308-0832
Mailing Address - Fax:682-308-0835
Practice Address - Street 1:1162 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6367
Practice Address - Country:US
Practice Address - Phone:682-308-0832
Practice Address - Fax:682-308-0835
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-72968106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18-72968OtherREGISTERED BEHAVIOR TECHNICIAN