Provider Demographics
NPI:1932372463
Name:YOUTH VILLAGES
Entity type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:615-423-1227
Mailing Address - Street 1:93 NANCE LN APT C8
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4341
Mailing Address - Country:US
Mailing Address - Phone:615-423-1227
Mailing Address - Fax:
Practice Address - Street 1:93 NANCE LN APT C8
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4341
Practice Address - Country:US
Practice Address - Phone:615-423-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health