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NPI Code Detail

MEDICARE: YOUTH OPPORTUNITY CENTER

MEDICARE: YOUTH OPPORTUNITY CENTER
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
1103TH0100XHealth Service Psychologist20042115AIN

Other Identifiers

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

General Provider Information

NPI Number : 1538319421
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUTH OPPORTUNITY CENTER
Provider Business Mailing Address
First Line : 3700 W KILGORE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-4810
Country : US
Telephone Number : 765-289-5437
Fax Number : 765-213-5094
Provider Business Practice Location Address
First Line : 3700 W KILGORE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-4810
Country : US
Telephone Number : 765-289-5437
Fax Number : 765-213-5094
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. RICHARD D. ROWRAY
Credential :
Telephone Number : 765-289-5437
Provider Enumeration Date : 09/26/2008
Last Update Date : 09/26/2008

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Directions to “YOUTH OPPORTUNITY CENTER ” Practice Location

Language Start Address Practice Location
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