Provider Demographics
NPI:1285309815
Name:YOUTH & FAMILY BEHAVIORAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:YOUTH & FAMILY BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE MARCELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-242-1079
Mailing Address - Street 1:2011 S 25TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4795
Mailing Address - Country:US
Mailing Address - Phone:772-242-1079
Mailing Address - Fax:772-242-1296
Practice Address - Street 1:2011 S 25TH ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4795
Practice Address - Country:US
Practice Address - Phone:772-242-1079
Practice Address - Fax:772-242-1296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH & FAMILY BEHAVIORAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
251B00000XOther251B00000X