Healthcare Provider Details

I. General information

NPI: 1205805454
Provider Name (Legal Business Name): CORINNE YOUNG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE YOUNG HARDESTY

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 WILLOWBROOK PKWY STE 300
INDIANAPOLIS IN
46205-1500
US

IV. Provider business mailing address

697 PRO MED LN
CARMEL IN
46032-5323
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax:
Mailing address:
  • Phone: 317-574-1254
  • Fax: 317-674-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042291A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042291A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: