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General NPI Number Information
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NPI Number | 1346421484
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Entity Type | Organization
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Legal Business Name | YOUTH CHALLENGE
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 519 ALABAMA ST
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City | COLUMBUS
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State | MS
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Zip | 39702-5305
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Country | US
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Telephone | 662-240-9788
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Fax | 662-240-9789
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Provider Business Mailing Address
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Address Line | 519 ALABAMA ST
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City | COLUMBUS
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State | MS
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Zip | 39702-5305
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Country | US
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Telephone | 662-240-9788
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Fax | 662-240-9789
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. AARON RAY PULSIFER
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Credential |
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Telephone | 662-240-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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