Healthcare Provider Details

I. General information

NPI: 1952494411
Provider Name (Legal Business Name): MOMI YAMANAKA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13295 ILLINOIS ST STE 123
CARMEL IN
46032-3020
US

IV. Provider business mailing address

13295 ILLINOIS ST STE 123
CARMEL IN
46032-3020
US

V. Phone/Fax

Practice location:
  • Phone: 317-983-1119
  • Fax: 888-443-4046
Mailing address:
  • Phone: 317-517-8817
  • Fax: 888-443-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number95000157A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20042030A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042030A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20042030A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: