Active NPI
John Young
- Clinical Social Worker
- San Benito, TX
National Provider Identifier
1487680161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 621
- Practice address
- 24986 Rice Tract Rd
San Benito, TX 78586-6660 - Phone
- (956) 361-2566
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1205 | TX | |
| Clinical Social Worker | 1041C0700X | 621 | TX | Primary |
| Marriage & Family Therapist | 106H00000X | 322 | TX |
Addresses
Primary practice location
24986 Rice Tract Rd
San Benito, TX 78586-6660
Mailing address
24986 Rice Tract Rd
San Benito, TX 78586-6660
Phone (956) 361-2566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0640948-01 | Medicaid | TX |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 621 | TX | MD | Clinical Social Worker |
| 322 | TX | MD | Marriage & Family Therapist |
| 1205 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287619200000",
"number": "1487680161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24986 RICE TRACT RD",
"city": "SAN BENITO",
"state": "TX",
"postal_code": "785866660",
"telephone_number": "956-361-2566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24986 RICE TRACT RD",
"city": "SAN BENITO",
"state": "TX",
"postal_code": "785866660",
"telephone_number": "956-361-2566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2010-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "1205",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "621",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "TX",
"license": "322",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0640948-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Benito, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.