MEDICARE: MS. DEANNA A YOUNG LCSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	34001948A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	076050000	OTHER	IN	MAGELLAN
3	000000183259	OTHER	IN	BC-BS

General Provider Information

NPI Number	:	1538188164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA A YOUNG LCSW, ACSW

Provider Business Mailing Address
First Line	:	2020 EAST WASHINGTON BLVD.
Second Line	:	SUITE 700
City	:	FORT WAYNE
State	:	IN
Zip	:	46803
Country	:	US
Telephone Number	:	260-422-3034
Fax Number	:	260-422-3691

Provider Business Practice Location Address
First Line	:	2020 EAST WASHINGTON BLVD
Second Line	:	SUITE 700
City	:	FORT WAYNE
State	:	IN
Zip	:	46803
Country	:	US
Telephone Number	:	260-422-3034
Fax Number	:	260-422-3691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/03/2011

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