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YOUTH FORM, LLC
NPI 1699528059
Social Worker - Clinical in Tallahassee, FL

Active since April 08, 2024
1018 THOMASVILLE RD, TALLAHASSEE, FL 32303(850) 296-2493 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Youth Form, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

YOUTH FORM, LLC (NPI 1699528059) is a healthcare organization registered as a clinical in Tallahassee, Florida and active in the NPI registry since April 2024. The organization lists Kortney Clinton, Founder/clinican, as its authorized official.

NPPES Registry Identity

NPI1699528059
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameYOUTH FORM, LLC
Location Address1018 THOMASVILLE RDTallahassee, FL 32303-8701
Mailing AddressPo Box 332Lloyd, FL 32337-0332 · (850) 296-2493
Phone(850) 296-2493
Organization SubpartNo
Authorized OfficialKortney ClintonFounder/clinican · (850) 296-2493
Enumeration DateApril 8, 2024
NPPES CertifiedApril 7, 2024
✔ NPI 1699528059 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
1018 THOMASVILLE RD, Tallahassee, FL 32303
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Youth Form, LLC's NPI number?

The NPI number for Youth Form, LLC is 1699528059. It was assigned to this organization in the NPPES registry on April 8, 2024.

Where is Youth Form, LLC located?

Youth Form, LLC is located at 1018 Thomasville Rd, Tallahassee, FL 32303. The listed phone number is (850) 296-2493.

What is Youth Form, LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Youth Form, LLC was last updated on April 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.