Healthcare Provider Details

I. General information

NPI: 1487299715
Provider Name (Legal Business Name): NATIONAL YOUTH ADVOCATE PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 WESTFORK DR STE 401
BATON ROUGE LA
70827-0004
US

IV. Provider business mailing address

1801 WATERMARK DR STE 200
COLUMBUS OH
43215-7088
US

V. Phone/Fax

Practice location:
  • Phone: 225-298-1290
  • Fax:
Mailing address:
  • Phone: 888-202-2965
  • Fax: 614-487-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE YVONNE LIZARDI
Title or Position: MEDICAID BILLING SPECIALIST II
Credential: CPC
Phone: 614-227-9430