Provider Demographics
NPI:1518346642
Name:YOUNG, ORVILLE 'ROBERT' JR
Entity type:Individual
Prefix:
First Name:ORVILLE
Middle Name:'ROBERT'
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ORVILLE
Other - Middle Name:'ROBERT'
Other - Last Name:YOUNG
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2103 S ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3615
Mailing Address - Country:US
Mailing Address - Phone:206-329-2050
Mailing Address - Fax:
Practice Address - Street 1:2103 S ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3615
Practice Address - Country:US
Practice Address - Phone:206-329-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60227144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health