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General NPI Number Information
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NPI Number | 1477885432
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Entity Type | Organization
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Legal Business Name | NEW HORIZONS YOUTH MINISTRIES
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 1002 S 350 E
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City | MARION
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State | IN
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Zip | 46953-9559
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Country | US
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Telephone | 765-668-4009
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Fax | 765-662-1407
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Provider Business Mailing Address
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Address Line | 1002 S 350 E
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City | MARION
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State | IN
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Zip | 46953-9559
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Country | US
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Telephone | 765-668-4009
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Fax | 765-662-1407
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TIMOTHY G BLOSSOM
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Credential |
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Telephone | 765-668-4009
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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 | 39001934A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33001688A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34002547A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35000968A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001283A
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 15546093333447
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License Number State | IN
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