Provider Demographics
NPI:1124331699
Name:YOUNG, TERESA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 EBNER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2361
Mailing Address - Country:US
Mailing Address - Phone:614-328-9528
Mailing Address - Fax:614-591-3015
Practice Address - Street 1:1520 OLD HENDERSON RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-328-9528
Practice Address - Fax:614-591-3015
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088250103TH0100X
390200000X
OHP.07947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program