Healthcare Provider Details

I. General information

NPI: 1609231992
Provider Name (Legal Business Name): MOMI YAMANAKA, PH.D. HSPP LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7739 E 88TH ST
INDIANAPOLIS IN
46256-1231
US

IV. Provider business mailing address

PO BOX 1064
CARMEL IN
46082-1064
US

V. Phone/Fax

Practice location:
  • Phone: 317-517-8817
  • 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 Number20042030A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number20042030A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20042030A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042030A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20042030A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number20042030A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1601241
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20042030A
License Number StateIN

VIII. Authorized Official

Name: DR. MOMI YAMANAKA
Title or Position: OWNER
Credential: PH.D. HSPP
Phone: 317-517-8817