Healthcare Provider Details

I. General information

NPI: 1356538383
Provider Name (Legal Business Name): YOUTH VILLAGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S WHEATLEY ST SUITE 240
RIDGELAND MS
39157-5000
US

IV. Provider business mailing address

3320 BROTHER BLVD
MEMPHIS TN
38133-8950
US

V. Phone/Fax

Practice location:
  • Phone: 601-572-3000
  • Fax: 601-372-3701
Mailing address:
  • Phone: 901-251-5000
  • Fax: 901-251-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK W. LAWLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 901-251-4801