Provider Demographics
NPI:1134220247
Name:YOUNG, WILLIAM BERNARD (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERNARD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E OAKMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6829
Mailing Address - Country:US
Mailing Address - Phone:714-628-9811
Mailing Address - Fax:
Practice Address - Street 1:594 N GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6748
Practice Address - Country:US
Practice Address - Phone:714-633-7247
Practice Address - Fax:714-633-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9978103TP0814X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL99780OtherBLUE SHIELD
CAPSY099780OtherMEDICAL
CA00PL99780OtherBLUE SHIELD
00PL99780Medicare UPIN