Provider Demographics
NPI:1629703673
Name:YOURTIME THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:YOURTIME THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ZADOK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMPALA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:319-541-1572
Mailing Address - Street 1:7448 MEADOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55444-2402
Mailing Address - Country:US
Mailing Address - Phone:319-541-1572
Mailing Address - Fax:
Practice Address - Street 1:7448 MEADOWWOOD DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55444-2402
Practice Address - Country:US
Practice Address - Phone:319-541-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27266OtherBOARD OF SOCIAL WORK