Provider Demographics
NPI:1891098687
Name:YOUNG, RODNEY EARL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:EARL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-0845
Mailing Address - Country:US
Mailing Address - Phone:859-567-1591
Mailing Address - Fax:859-567-1253
Practice Address - Street 1:441 US HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-7513
Practice Address - Country:US
Practice Address - Phone:859-567-1271
Practice Address - Fax:859-567-1253
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY370817Medicaid