Provider Demographics
NPI:1619420130
Name:YOUTH & FAMILY BEHAVIORAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:YOUTH & FAMILY BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:772-242-1079
Mailing Address - Street 1:2011 S 25TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4795
Mailing Address - Country:US
Mailing Address - Phone:772-242-1079
Mailing Address - Fax:
Practice Address - Street 1:2011 S 25TH ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4795
Practice Address - Country:US
Practice Address - Phone:772-242-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018691700Medicaid