MEDICARE: NATIONAL YOUTH ADVOCATE PROGRAM, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750036992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL YOUTH ADVOCATE PROGRAM, INC

Provider Business Mailing Address
First Line	:	1801 WATERMARK DR STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7088
Country	:	US
Telephone Number	:	614-487-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLAZA 31 3140 N. VERMILLION
Second Line	:	SUITE 202
City	:	DANVILLE
State	:	IL
Zip	:	61832-6044
Country	:	US
Telephone Number	:	708-747-2655
Fax Number	:	708-747-2859

Authorized Official
Title or Position	:	DIRECTOR OF DEVELOPMENT
Name	:	SHELIA OWENS
Credential	:
Telephone Number	:	708-747-2655

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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