MEDICARE: FRIENDS OF CHILDREN YOUTH AND FAMILIES, INC

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	101YM0800X	Mental Health Counselor

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	:	1477861003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS OF CHILDREN YOUTH AND FAMILIES, INC

Provider Business Mailing Address
First Line	:	2323 HANSEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-4859
Country	:	US
Telephone Number	:	850-894-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 HANSEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-4859
Country	:	US
Telephone Number	:	850-894-3700
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND PRESIDENT
Name	:	DR. WILLIE MYLES
Credential	:	EDD
Telephone Number	:	954-578-8399

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	09/16/2010

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