Provider Demographics
NPI:1649480930
Name:YOUTH VILLAGES
Entity type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERCEPT FAMILY COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LASHONE
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-282-9486
Mailing Address - Street 1:1504 COUNTY ROAD 402
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-8201
Mailing Address - Country:US
Mailing Address - Phone:901-282-9486
Mailing Address - Fax:
Practice Address - Street 1:1504 COUNTY ROAD 402
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-8201
Practice Address - Country:US
Practice Address - Phone:901-282-9486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health