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General NPI Number Information
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NPI Number | 1447584610
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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 | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 6301 CTRL AVE SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-2036
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Country | US
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Telephone | 505-831-6038
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Fax | 505-232-9017
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Provider Business Mailing Address
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Address Line | 6301 CTRL AVE SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-2036
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Country | US
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Telephone | 505-831-6038
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MS. IMANI TURTLE-SONG
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Credential | LPCC
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Telephone | 505-232-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0069042
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License Number State | NM
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