Basic Information
| Provider Information | |||||||||
| NPI: | 1750036992 | ||||||||
| 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | PLAZA 31 3140 N. VERMILLION | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618326044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087472655 | ||||||||
| FaxNumber: | 7087472859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2022 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | SHELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 7087472655 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.