Provider Demographics
NPI:1336341163
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:423-954-8840
Mailing Address - Street 1:5726 MARLIN RD
Mailing Address - Street 2:FRANKLIN BUILDING, SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4008
Mailing Address - Country:US
Mailing Address - Phone:423-954-8890
Mailing Address - Fax:423-954-8880
Practice Address - Street 1:5726 MARLIN RD
Practice Address - Street 2:FRANKLIN BUILDING, SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4008
Practice Address - Country:US
Practice Address - Phone:423-954-8890
Practice Address - Fax:423-954-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health