Provider Demographics
NPI:1770208878
Name:YOUNG, TANNER (BCBA)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARK WEST DR
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-8911
Mailing Address - Country:US
Mailing Address - Phone:337-233-1167
Mailing Address - Fax:
Practice Address - Street 1:300 PARK WEST DR
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8911
Practice Address - Country:US
Practice Address - Phone:337-233-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst