Idea Youth Success Center

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

IDEA YOUTH SUCCESS CENTER

Practice address

1518 Vaughn Blvd
Fort Worth, TX 76105-2307

Phone

(214) 515-2079

NPI assigned

Jun 5, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Detitria Woodard

Title

Owner

Phone

(214) 515-2079

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Illya Jackson

  • Marriage & Family Therapist
  • Ft Worth, TX
  • NPI 1700269149
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1013397892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 CHAPEL PL",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751041760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1518 VAUGHN BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761052307",
            "telephone_number": "214-515-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEA YOUTH SUCCESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "DETITRIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-515-2079",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Earl Icaza, MD
• Patricia Lee Ice
• Victoria Icho, M.S., LMFT ASSOCIATE
• Iconiq Spine & Orthopaedic Center PLLC
• Dominique Kwaine Idahor
• Ideal Dental of Clifford Crossing PLLC
• Ideal Dental of Fort Worth, PLLC
• Ideal Dental of Waterside PLLC
• Ideal Dental of West 7TH PLLC
• Idexpertcare PA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.