Provider Demographics
NPI:1346421484
Name:YOUTH CHALLENGE
Entity Type:Organization
Organization Name:YOUTH CHALLENGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PULSIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-240-9788
Mailing Address - Street 1:519 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5305
Mailing Address - Country:US
Mailing Address - Phone:662-240-9788
Mailing Address - Fax:662-240-9789
Practice Address - Street 1:519 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5305
Practice Address - Country:US
Practice Address - Phone:662-240-9788
Practice Address - Fax:662-240-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05536560Medicaid