MEDICARE: YOUTH EMPOWERMENT INITIATIVE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720922255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH EMPOWERMENT INITIATIVE

Provider Business Mailing Address
First Line	:	309 VINE ST APT 904
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-3654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 VINE ST APT 904
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-3654
Country	:	US
Telephone Number	:	513-285-3707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HALSEY MABRY
Credential	:
Telephone Number	:	513-285-3707

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “YOUTH EMPOWERMENT INITIATIVE ” Practice Location

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