MEDICARE: WESTERN YOUTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1023142379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN YOUTH SERVICES

Provider Business Mailing Address
First Line	:	18350 MOUNT LANGLEY ST STE 206, 215, 220, 200
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6900
Country	:	US
Telephone Number	:	714-378-2620
Fax Number	:	714-378-2631

Provider Business Practice Location Address
First Line	:	18350 MOUNT LANGLEY ST STE 206, 215, 220, 200
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6900
Country	:	US
Telephone Number	:	714-378-2620
Fax Number	:	714-378-2631

Authorized Official
Title or Position	:	CEO
Name	:	DR. LORRAYNE LEIGH BELHUMEUR
Credential	:	PH.D.
Telephone Number	:	949-855-1556

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/07/2019

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Directions to “WESTERN YOUTH SERVICES ” Practice Location

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