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General NPI Number Information
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NPI Number | 1013089002
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Entity Type | Organization
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Legal Business Name | YOUTH DEVELOPMENT INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1820 SAN PEDRO DR NE SUITE 7 & 8
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5937
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Country | US
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Telephone | 505-232-9015
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Fax | 505-232-9017
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Provider Business Mailing Address
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Address Line | 1710 EL CENTRO FAMILIAR BLVD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-4502
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Country | US
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Telephone | 505-873-1604
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Fax | 505-877-3533
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LYNDA MOORE
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Credential | LPCC
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Telephone | 505-873-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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