Provider Demographics
NPI:1730300245
Name:YOUNG, PHILIP ANDREW
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
Last Name:YOUNG
Suffix:
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 1:1200 S AIR DEPOT BLVD STE O
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4848
Mailing Address - Country:US
Mailing Address - Phone:405-931-9811
Mailing Address - Fax:
Practice Address - Street 1:1200 S AIR DEPOT BLVD STE O
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4848
Practice Address - Country:US
Practice Address - Phone:405-931-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)