Healthcare Provider Details

I. General information

NPI: 1366655722
Provider Name (Legal Business Name): YOUNG-RIVERS ASSOCIATES, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 ASHLEYWOOD CT.
LOUISVILLE KY
40241-1582
US

IV. Provider business mailing address

4228 ASHLEYWOOD CT.
LOUISVILLE KY
40241-1582
US

V. Phone/Fax

Practice location:
  • Phone: 502-644-0007
  • Fax:
Mailing address:
  • Phone: 502-644-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0722
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0722
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0722
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0722
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number0722
License Number StateKY

VIII. Authorized Official

Name: DR. ROBIN YOUNG PORTER
Title or Position: OWNER
Credential: PH.D.
Phone: 502-644-0007