Basic Information
| Provider Information | |||||||||
| NPI: | 1003010281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | B.S. MUSIC THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18052 BENETA WAY | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143921077 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18052 BENETA WAY | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143921077 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.