Provider Demographics
NPI:1801918966
Name:YOUTH DYNAMICS, INC.
Entity type:Organization
Organization Name:YOUTH DYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
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:406-245-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10890385HR2055X, 251B00000X, 251S00000X
322D00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0320411Medicaid
MT0255493Medicaid
MT0320603Medicaid
MT0290428Medicaid
MT0350778Medicaid
MT0502401Medicaid