Healthcare Provider Details

I. General information

NPI: 1831051440
Provider Name (Legal Business Name): TEARA NICOLE YOUNG MSN, MBA, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 CHAGRIN BLVD STE 125
BEACHWOOD OH
44122-5535
US

IV. Provider business mailing address

8584 WASHINGTON ST STE 2023
CHAGRIN FALLS OH
44023-5305
US

V. Phone/Fax

Practice location:
  • Phone: 833-254-3278
  • Fax: 800-879-1741
Mailing address:
  • Phone: 216-300-7500
  • Fax: 216-300-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025060922
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: