Provider Demographics
NPI:1831695907
Name:YOUNG, MARCUS LAKEITH SR
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:LAKEITH
Last Name:YOUNG
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N GAY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6110
Mailing Address - Country:US
Mailing Address - Phone:850-831-3530
Mailing Address - Fax:
Practice Address - Street 1:626 N GAY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6110
Practice Address - Country:US
Practice Address - Phone:850-831-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst