| Organization Name: | EDIFY YOUTH |
| NPI Number: | 1477895985 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELE BAUER (ADMINISTRATOR) |
| Mailing Address: | 5108 Lakeside Ave N Crystal |
| State: | MN US |
| Postal Code: | 554293734 |
| Phone Number: | 6123064575 |
| Fax Number: | 7632712707 |
| NPI Enumeration Date: | 03/22/2013 |
| NPI Last Update Date: | 03/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |