Provider Demographics
NPI:1477861003
Name:FRIENDS OF CHILDREN YOUTH AND FAMILIES, INC
Entity Type:Organization
Organization Name:FRIENDS OF CHILDREN YOUTH AND FAMILIES, INC
Other - Org Name:FRIENDS OF CHILDREN, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:954-578-8399
Mailing Address - Street 1:2323 HANSEN CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4859
Mailing Address - Country:US
Mailing Address - Phone:850-894-3700
Mailing Address - Fax:
Practice Address - Street 1:2323 HANSEN CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4859
Practice Address - Country:US
Practice Address - Phone:850-894-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDS OF CHILDREN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076141900Medicaid