Young, Kenneth Ray

Young, Kenneth Ray is an individual health care provider with primary practice located at 9055 Springbrook Dr Nw , Coon Rapids MN 55433-5841. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Young, Kenneth Ray can be contacted via phone (763) 780-9155.

Contact Information

Primary practice address
9055 Springbrook Dr Nw Coon Rapids MN 55433-5841
Phone: (763) 780-9155
Fax: (763) 236-1066
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP5036 Minnesota
Behavioral Health & Social Service Providers / Forensic 103TF0200X LP5036 Minnesota
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP5036 Minnesota
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X LP5036 Minnesota

Profile Details

NPI number 1083927917
LBN Legal business name Young, Kenneth Ray
Credentials PSYD, LP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2010
Last updated Dec 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083927917 NPPES
Minnesota MEDICAID 1083927917

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