Provider Demographics
NPI:1811022809
Name:YOUNG, KELLY C
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1305
Mailing Address - Country:US
Mailing Address - Phone:317-941-2200
Mailing Address - Fax:317-941-2208
Practice Address - Street 1:2011 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1305
Practice Address - Country:US
Practice Address - Phone:317-941-2200
Practice Address - Fax:317-941-2208
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health