MEDICARE: FLOURISH YOUTH, 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	101YM0800X	Mental Health Counselor
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1548128846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH YOUTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 23194
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-0274
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14019 THOMPSON RD
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-1516
Country	:	US
Telephone Number	:	704-975-6118
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JESSE TALL
Credential	:
Telephone Number	:	704-975-6118

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “FLOURISH YOUTH, LLC ” Practice Location

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