Organization
NATIONAL YOUTH ADVOCATE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN L CLUTS (SYSTEMS ANALYST)
(614) 487-8758
Entity
Organization
Contact information
Practice address
13101 S BALTIMORE AVE, CHICAGO, IL 60633-1318
(773) 270-6733
Mailing address
1801 WATERMARK DR, COLUMBUS, OH 43215-7088
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
05/17/2024
Last updated
06/17/2024
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