MEDICARE: NATIONAL YOUTH ADVOCATE PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235408022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL YOUTH ADVOCATE PROGRAM

Provider Business Mailing Address
First Line	:	1801 WATERMARK DR
Second Line	:	STE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7088
Country	:	US
Telephone Number	:	888-202-2965
Fax Number	:	614-487-8759

Provider Business Practice Location Address
First Line	:	4701 N KEYSTONE AVE STE 150
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1562
Country	:	US
Telephone Number	:	800-471-4795
Fax Number	:	317-475-0081

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MARVENA TWIGG
Credential	:
Telephone Number	:	888-202-2965

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	03/05/2019

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Directions to “NATIONAL YOUTH ADVOCATE PROGRAM ” Practice Location

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