Provider Demographics
NPI:1578707246
Name:YOUTH ADVOCATE PROGRAM
Entity Type:Organization
Organization Name:YOUTH ADVOCATE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMHP-CS
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LYNET
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-735-3094
Mailing Address - Street 1:4225 OFFICE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TEXAS
Mailing Address - Zip Code:75204
Mailing Address - Country:UM
Mailing Address - Phone:214-821-6505
Mailing Address - Fax:
Practice Address - Street 1:2007 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1815
Practice Address - Country:US
Practice Address - Phone:717-232-7580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH ADVOCATE PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management