Provider Demographics
NPI:1871162685
Name:YOUNG, ANITRA ZOE (RBT)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:ZOE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 DEWEY AVE APT G
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3056
Mailing Address - Country:US
Mailing Address - Phone:224-456-4766
Mailing Address - Fax:
Practice Address - Street 1:2110 DEWEY AVE APT G
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3056
Practice Address - Country:US
Practice Address - Phone:224-456-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARBT-20-148571106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician