Provider Demographics
NPI:1144542127
Name:YOUTH SERVICE BUREAU
Entity type:Organization
Organization Name:YOUTH SERVICE BUREAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:812-423-5816
Mailing Address - Street 1:734 W DELAWARE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1667
Mailing Address - Country:US
Mailing Address - Phone:812-423-5816
Mailing Address - Fax:812-423-5294
Practice Address - Street 1:734 W DELAWARE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1667
Practice Address - Country:US
Practice Address - Phone:812-423-5816
Practice Address - Fax:812-423-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002097A101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty