Healthcare Provider Details

I. General information

NPI: 1225172646
Provider Name (Legal Business Name): DAVID M YOUNG HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W CHERRY ST
BLUFFTON IN
46714-2008
US

IV. Provider business mailing address

105 W CHERRY ST
BLUFFTON IN
46714-2008
US

V. Phone/Fax

Practice location:
  • Phone: 260-307-5030
  • Fax: 260-307-5461
Mailing address:
  • Phone: 260-307-5030
  • Fax: 260-307-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010292A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20010292A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010292A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: