Provider Demographics
NPI:1780284356
Name:YOUNG, TYLER (LCSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37815 CHESTERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4501
Mailing Address - Country:US
Mailing Address - Phone:760-834-4452
Mailing Address - Fax:
Practice Address - Street 1:37815 CHESTERFIELD ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-4501
Practice Address - Country:US
Practice Address - Phone:760-834-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1255241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical