Provider Demographics
NPI:1932884186
Name:RESILIENT YOUTH, PLLC
Entity Type:Organization
Organization Name:RESILIENT YOUTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-719-9701
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-0211
Mailing Address - Country:US
Mailing Address - Phone:304-719-9701
Mailing Address - Fax:
Practice Address - Street 1:402 CHURCH ST STE 2
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1495
Practice Address - Country:US
Practice Address - Phone:304-719-9701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty