Active NPI
Timothy Dewayne Young
- Behavior Analyst
- Shawnee, OK
National Provider Identifier
1104103886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 1317 E Wallace St
Shawnee, OK 74801-6412 - Phone
- (405) 243-3798
- NPI assigned
- Nov 9, 2011
- Last updated
- Nov 9, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | OK | Primary |
Addresses
Primary practice location
1317 E Wallace St
Shawnee, OK 74801-6412
Mailing address
1317 E. Wallace St.
Shawnee, OK 74801-6412
Phone (405) 243-3798
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320796800000",
"number": "1104103886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1317 E. WALLACE ST.",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748016412",
"telephone_number": "405-243-3798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 E WALLACE ST",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748016412",
"telephone_number": "405-243-3798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "TIMOTHY",
"middle_name": "DEWAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-09",
"last_updated": "2011-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.