Basic Information
| Provider Information | |||||||||
| NPI: | 1538595004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL YOUTH ADVOCATE PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 WATERMARK DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886889964 | ||||||||
| FaxNumber: | 6144873819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 MERIDIAN ST | ||||||||
| Address2: | STE 106 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460162776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174731131 | ||||||||
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| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | TWIGG | ||||||||
| AuthorizedOfficialFirstName: | MARVENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8886889964 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.