Provider Demographics
NPI:1982984761
Name:YOUNG, KATLIN L
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:L
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 1:101 S WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3867
Mailing Address - Country:US
Mailing Address - Phone:765-662-9971
Mailing Address - Fax:765-651-6563
Practice Address - Street 1:101 S WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3867
Practice Address - Country:US
Practice Address - Phone:765-662-9971
Practice Address - Fax:765-651-6563
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100124250Medicaid