Provider Demographics
NPI:1083961635
Name:NATIONAL INITIATIVES FOR HEALTHY YOUTH
Entity Type:Organization
Organization Name:NATIONAL INITIATIVES FOR HEALTHY YOUTH
Other - Org Name:FORENSIC PSYCHOLOGICAL SERVICES FOR YOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-229-2753
Mailing Address - Street 1:7948 QUAIL AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2423
Mailing Address - Country:US
Mailing Address - Phone:763-568-7340
Mailing Address - Fax:
Practice Address - Street 1:7948 QUAIL AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2423
Practice Address - Country:US
Practice Address - Phone:763-568-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC003709103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty