Basic Information
| Provider Information | |||||||||
| NPI: | 1477147676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL YOUTH ADVOCATE PROGRAM, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 WATERMARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144878758 | ||||||||
| FaxNumber: | 7087472859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2431 BETHANY RD STE B | ||||||||
| Address2: | |||||||||
| City: | SYCAMORE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601783136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155171585 | ||||||||
| FaxNumber: | 8158276203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2021 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | TWIGG | ||||||||
| AuthorizedOfficialFirstName: | MARVENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6144878758 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | N | Agencies | Foster Care Agency | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.