1538188164 NPI number — MS. DEANNA A YOUNG LCSW, ACSW

Table of content: MS. DEANNA A YOUNG LCSW, ACSW (NPI 1538188164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538188164 NPI number — MS. DEANNA A YOUNG LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
DEANNA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538188164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 EAST WASHINGTON BLVD.
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-422-3034
Provider Business Mailing Address Fax Number:
260-422-3691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 EAST WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-422-3034
Provider Business Practice Location Address Fax Number:
260-422-3691
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  34001948A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100440190A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 076050000 . This is a "MAGELLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000183259 . This is a "BC-BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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