Provider Demographics
NPI:1821630021
Name:YOUTH DYNAMICS, INC.
Entity Type:Organization
Organization Name:YOUTH DYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-245-6539
Mailing Address - Street 1:2334 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3927
Mailing Address - Country:US
Mailing Address - Phone:406-245-6539
Mailing Address - Fax:406-245-3192
Practice Address - Street 1:2334 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3927
Practice Address - Country:US
Practice Address - Phone:406-245-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1902025067Medicaid
MT1801918966Medicaid