Healthcare Provider Details

I. General information

NPI: 1376407064
Provider Name (Legal Business Name): NATIONAL YOUTH ADVOCATE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E 87TH ST STE B
CHICAGO IL
60619-6104
US

IV. Provider business mailing address

740 E 87TH ST STE B
CHICAGO IL
60619-6104
US

V. Phone/Fax

Practice location:
  • Phone: 888-728-5175
  • Fax:
Mailing address:
  • Phone: 888-728-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN L CLUTS
Title or Position: SYSTEM ANALYST
Credential:
Phone: 614-487-8758