Provider Demographics
NPI:1568998094
Name:MVP YOUTH, INC.
Entity Type:Organization
Organization Name:MVP YOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LCPC
Authorized Official - Phone:814-494-1116
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-0826
Mailing Address - Country:US
Mailing Address - Phone:240-803-9647
Mailing Address - Fax:
Practice Address - Street 1:150 CENTER ST
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1817
Practice Address - Country:US
Practice Address - Phone:240-803-9647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7562251300000X, 251S00000X, 251V00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency