Organization
THE YOUTH SPOT
Active
Other names
OUR Youth Mentoring
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY JOHNSON (CONSULTANT)
(773) 841-4368
Entity
Organization
Contact information
Practice address
3960 W GRAND AVE, CHICAGO, IL 60651-2014
(872) 803-2130
Mailing address
3960 W GRAND AVE, CHICAGO, IL 60651-2014
(872) 803-2130
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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