MEDICARE: NATIONAL YOUTH ADVOCATE PROGRAM

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912718669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL YOUTH ADVOCATE PROGRAM

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	:	614-487-8759

Provider Business Practice Location Address
First Line	:	955 175TH ST
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2028
Country	:	US
Telephone Number	:	708-747-2655
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MARVENA TWIGG
Credential	:
Telephone Number	:	888-202-2965

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	06/15/2026

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