| Youth Bridge | |
|
2153 East Joyce Boulevard Fayetteville AR 72703 | |
| (479) 521-1532 | |
| Not Available |
| Full Name | Youth Bridge |
|---|---|
| Speciality | Counselor |
| Location | 2153 East Joyce Boulevard, Fayetteville, Arkansas |
| Authorized Official Name and Position | Kathy Lott (PROGRAM DIRECTOR) |
| Authorized Official Contact | 4795211532 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Youth Bridge 2153 East Joyce Boulevard Fayetteville AR 72703 Ph: (479) 521-1532 | Youth Bridge 2153 East Joyce Boulevard Fayetteville AR 72703 Ph: (479) 521-1532 |
| NPI Number | 1578906590 |
|---|---|
| Provider Enumeration Date | 04/09/2013 |
| Last Update Date | 04/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578906590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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