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Organization
YOUTHCENTRIX THERAPY SERVICES
Active
Organization
YOUTHCENTRIX THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA LONG (MANAGER)
(469) 662-6729
Entity
Organization
Contact information
Practice address
12 SAFFRIN HILL CT, GLEN CARBON, IL 62034-1561
(469) 662-6729
Mailing address
1 OAK DR, #203, MARYVILLE, IL 62062-7004
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
12/26/2016
Last updated
12/29/2016
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