Provider Demographics
NPI:1184210684
Name:CONNECTING YOUTH ACHIEVEMENT CENTER & CONSULTING
Entity Type:Organization
Organization Name:CONNECTING YOUTH ACHIEVEMENT CENTER & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RELEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-408-8138
Mailing Address - Street 1:2494 ROYCROFT ALY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-8609
Mailing Address - Country:US
Mailing Address - Phone:319-408-8138
Mailing Address - Fax:
Practice Address - Street 1:2494 ROYCROFT ALY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-8609
Practice Address - Country:US
Practice Address - Phone:319-408-8138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health