Provider Demographics
NPI:1225172646
Name:YOUNG, DAVID M (HSPP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2008
Mailing Address - Country:US
Mailing Address - Phone:260-307-5030
Mailing Address - Fax:260-307-5461
Practice Address - Street 1:105 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2008
Practice Address - Country:US
Practice Address - Phone:260-307-5030
Practice Address - Fax:260-307-5461
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010292A103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent