Healthcare Provider Details

I. General information

NPI: 1134183452
Provider Name (Legal Business Name): JEAN F YOUNGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 DEPAUW BLVD SUITE 2052
INDIANAPOLIS IN
46268-1170
US

IV. Provider business mailing address

3500 DEPAUW BLVD SUITE 2052
INDIANAPOLIS IN
46268-1170
US

V. Phone/Fax

Practice location:
  • Phone: 317-731-4923
  • Fax:
Mailing address:
  • Phone: 317-731-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35001547A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: