Healthcare Provider Details

I. General information

NPI: 1124331699
Provider Name (Legal Business Name): TERESA ANNE YOUNG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 OLD HENDERSON RD STE E
COLUMBUS OH
43220
US

IV. Provider business mailing address

855 EBNER ST
COLUMBUS OH
43206-2361
US

V. Phone/Fax

Practice location:
  • Phone: 614-328-9528
  • Fax: 614-591-3015
Mailing address:
  • Phone: 614-328-9528
  • Fax: 614-591-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.07947
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071022643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: