Provider Demographics
NPI:1952873374
Name:YOUNG, JASON WAYNE (RADT-1)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WAYNE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 SANTIAGO CT # CY
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9534
Mailing Address - Country:US
Mailing Address - Phone:209-233-8989
Mailing Address - Fax:
Practice Address - Street 1:3522 SANTIAGO CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9534
Practice Address - Country:US
Practice Address - Phone:209-233-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty