Provider Demographics
NPI:1790923654
Name:THE YOUTH ADVOCATE PROGRAM INC.
Entity Type:Organization
Organization Name:THE YOUTH ADVOCATE PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-422-7864
Mailing Address - Street 1:202 E ELDORADO ST STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1036
Mailing Address - Country:US
Mailing Address - Phone:217-422-7864
Mailing Address - Fax:217-422-1324
Practice Address - Street 1:202 E ELDORADO ST STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1036
Practice Address - Country:US
Practice Address - Phone:217-422-7864
Practice Address - Fax:217-422-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health