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General NPI Number Information
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NPI Number | 1124331699
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Entity Type | Individual
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Provider Name | TERESA ANNE YOUNG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1520 OLD HENDERSON RD STE E
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City | COLUMBUS
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State | OH
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Zip | 43220
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Country | US
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Telephone | 614-328-9528
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Fax | 614-591-3015
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Provider Business Mailing Address
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Address Line | 855 EBNER ST
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City | COLUMBUS
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State | OH
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Zip | 43206-2361
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Country | US
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Telephone | 614-328-9528
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Fax | 614-591-3015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 088250
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P.07947
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License Number State | OH
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