Active NPI
Richard J Young, PH.D.
- Clinical Psychologist
- Saint Paul, MN
National Provider Identifier
1255517256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4534
- Practice address
- 640 Jackson St
Saint Paul, MN 55101-2502 - Phone
- (952) 883-7172
- NPI assigned
- Jan 21, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4534 | MN | Primary |
Addresses
Primary practice location
640 Jackson St
Saint Paul, MN 55101-2502
Mailing address
13736 Danbury Path
Rosemount, MN 55068-3329
Phone (651) 587-6796
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)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4534 | MN | MD | Clinical Psychologist |
| 5310 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1255517256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13736 DANBURY PATH",
"city": "ROSEMOUNT",
"state": "MN",
"postal_code": "550683329",
"telephone_number": "651-587-6796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 JACKSON ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551012502",
"telephone_number": "952-883-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "RICHARD",
"middle_name": "J",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-21",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "4534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.