Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1295096022 |
---|---|
Provider Name | Erica Antionette Young |
First Address | Oklahoma City, OK 73159-7122 |
Second Address | Oklahoma City, OK 73159-7122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 07/06/2012 |