Youth Form, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

YOUTH FORM, LLC

Practice address

1018 Thomasville Rd
Tallahassee, FL 32303-8701

Phone

(850) 296-2493

NPI assigned

Apr 8, 2024

Organization subpart

No

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

Authorized official

Name

Kortney Clinton

Title

Founder/Clinican

Phone

(850) 296-2493

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1699528059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 332",
            "city": "LLOYD",
            "state": "FL",
            "postal_code": "323370332",
            "telephone_number": "850-296-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 THOMASVILLE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323038701",
            "telephone_number": "850-296-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH FORM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-07",
        "status": "A",
        "authorized_official_last_name": "CLINTON",
        "authorized_official_first_name": "KORTNEY",
        "authorized_official_title_or_position": "FOUNDER/CLINICAN",
        "authorized_official_telephone_number": "850-296-2493"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Young
• Nancy L Young, R MR
• Robin Young, D.D.S.
• Mohamed Aly Ibrahim Youssef, DMD
• Tereze Youssef
• Youthful Aging Healthcare Services LLC.
• Samuel D Yu, MD
• Yu Yu, MD
• Cassandra Evelyn Yusz, MPAS, PA-C
• Zabella Group Homes LLC

• Clinical Social Worker in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.