Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Youth Form, LLC

Organization Clinical Social Worker · NPI 1699528059

Youth Form, LLC is a Clinical Social Worker in Tallahassee, Florida. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1018 Thomasville Rd
Tallahassee, FL 32303-8701
Phone: (850) 296-2493
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1699528059
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kortney Clinton — Founder/Clinican · (850) 296-2493
NPI enumeratedApril 8, 2024
Last updated in NPPESApril 8, 2024
Certification dateApril 7, 2024
Mailing addressPo Box 332, Lloyd, FL 32337-0332

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