Individual provider Active NPI

William Bernard Young, PHD

  • Clinical Psychologist
  • Orange, CA
National Provider Identifier
1134220247
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY9978 Issued in CA
Practice address
594 N Glassell St
Orange, CA 92867-6748
Phone
(714) 633-7247
Fax
(714) 633-7224
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychoanalysis Psychologist 103TP0814X PSY9978 CA
Group Psychotherapy Psychologist 103TP2701X PSY9978 CA
Clinical Psychologist 103TC0700X PSY9978 CA Primary

Addresses

Primary practice location

594 N Glassell St
Orange, CA 92867-6748

Mailing address

341 E Oakmont Ave
Orange, CA 92867-6829
Phone (714) 628-9811

Other identifiers 2

IdentifierTypeStateIssuer
00PL99780OtherCABLUE SHIELD
PSY099780OtherCAMEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091112000476 CA Practitioner - Clinical Psychologist 3072651918 Practice locations: Orange, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

594 N Glassell St
Orange, CA 92867-6748
Phone (714) 633-7247

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY9978CAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1134220247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 E OAKMONT AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928676829",
            "telephone_number": "714-628-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 N GLASSELL ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928676748",
            "telephone_number": "714-633-7247",
            "fax_number": "714-633-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "WILLIAM",
        "middle_name": "BERNARD",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": "CA",
            "license": "PSY9978",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY9978",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY9978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00PL99780",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "PSY099780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.