Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6133 | OH |
N | 103T00000X | Psychologist | 6133 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6133 | OH |
Y | 103G00000X | Clinical Psychologist | 6133 | OH |
Y | 103TC0700X | Clinical Psychologist | 6133 | OH |
N | 103TC1900X | Counseling Psychologist | 6133 | OH |
N | 103TP2701X | Group Psychotherapist | 6133 | OH |
NPI | 1154398584 |
---|---|
Provider Name | Dr. Graham David Young |
First Address | Shaker Heights, OH 44122-3038 |
Second Address | Cleveland, OH 44114-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 05/04/2021 |