Provider Demographics
NPI:1609231992
Name:MOMI YAMANAKA, PH.D. HSPP LLC.
Entity Type:Organization
Organization Name:MOMI YAMANAKA, PH.D. HSPP LLC.
Other - Org Name:PSYCHOLOGY AND COUNSELING ASSOCIATES OF CARMEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD HSPP
Authorized Official - Phone:317-517-8817
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-1064
Mailing Address - Country:US
Mailing Address - Phone:317-517-8817
Mailing Address - Fax:888-443-4046
Practice Address - Street 1:7739 E 88TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1231
Practice Address - Country:US
Practice Address - Phone:317-517-8817
Practice Address - Fax:888-443-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042030A103K00000X, 103TA0400X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X
IN1601241103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200913370AMedicaid
IN266090Medicare UPIN