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General NPI Number Information
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NPI Number | 1841943495
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Entity Type | Organization
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Legal Business Name | NATIONAL YOUTH ADVOCATE PROGRAM, INC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 7479 WALTON ST STE 4
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City | ROCKFORD
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State | IL
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Zip | 61108-4613
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Country | US
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Telephone | 708-747-2655
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 WATERMARK DR STE 200
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City | COLUMBUS
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State | OH
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Zip | 43215-7088
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Country | US
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Telephone | 614-487-8758
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Fax | 614-487-8759
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHELIA OWENS
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Credential |
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Telephone | 708-747-2655
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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