Provider Demographics
NPI:1649390881
Name:FRIENDS TO YOUTH INC.
Entity Type:Organization
Organization Name:FRIENDS TO YOUTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-2662
Mailing Address - Street 1:1515 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4929
Mailing Address - Country:US
Mailing Address - Phone:406-728-2662
Mailing Address - Fax:406-728-2879
Practice Address - Street 1:1515 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4929
Practice Address - Country:US
Practice Address - Phone:406-728-2662
Practice Address - Fax:406-728-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT621420251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503999Medicaid
MT0503285Medicaid
MT0503608Medicaid