Provider Demographics
NPI:1578355749
Name:EMPOWERYOUTH LLC
Entity type:Organization
Organization Name:EMPOWERYOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAQUELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:219-201-9446
Mailing Address - Street 1:PO BOX 10613
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0613
Mailing Address - Country:US
Mailing Address - Phone:219-201-9446
Mailing Address - Fax:
Practice Address - Street 1:7895 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5529
Practice Address - Country:US
Practice Address - Phone:219-247-8938
Practice Address - Fax:219-293-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty