MEDICARE: UPLIFTING YOUTH AND FAMILY COUNSELING SERVICES,LLC

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	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120	OTHER		120 HOME ADDRESS

General Provider Information

NPI Number	:	1508342544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFTING YOUTH AND FAMILY COUNSELING SERVICES,LLC

Provider Business Mailing Address
First Line	:	120 KIMRICK CIR
Second Line	:
City	:	DEATSVILLE
State	:	AL
Zip	:	36022-2673
Country	:	US
Telephone Number	:	334-657-3836
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 INTERSTATE COMMERCIAL PARK LOOP
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-7361
Country	:	US
Telephone Number	:	334-657-3836
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARCUS TREMAYNE SIMMONS
Credential	:	MS
Telephone Number	:	334-657-3836

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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