Healthcare Provider Details

I. General information

NPI: 1902025067
Provider Name (Legal Business Name): YOUTH DYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 LEWIS AVE
BILLINGS MT
59102-3927
US

IV. Provider business mailing address

2334 LEWIS AVE
BILLINGS MT
59102-3927
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-6539
  • Fax: 406-245-3192
Mailing address:
  • Phone: 406-245-6539
  • Fax: 406-245-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10890
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10890
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10890
License Number StateMT

VIII. Authorized Official

Name: LESLIE FALCON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 406-245-6539