MEDICARE: HEALTHY YOUNG MINDS CALIFORNIA PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	101Y00000X	Counselor
4	101YM0800X	Mental Health Counselor
5	103K00000X	Behavior Analyst
6	103T00000X	Psychologist
7	103TA0400X	Addiction (Substance Use Disorder) Psychologist
8	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
9	2084P0804X	Child & Adolescent Psychiatry Physician
10	221700000X	Art Therapist
11	103TB0200X	Cognitive & Behavioral Psychologist
12	103TC0700X	Clinical Psychologist
13	1041C0700X	Clinical Social Worker
14	2080P0006X	Developmental - Behavioral Pediatrics Physician
15	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1962227009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY YOUNG MINDS CALIFORNIA PC

Provider Business Mailing Address
First Line	:	PO BOX 6080
Second Line	:
City	:	VAIL
State	:	CO
Zip	:	81658-6080
Country	:	US
Telephone Number	:	303-317-6504
Fax Number	:	800-878-7002

Provider Business Practice Location Address
First Line	:	7946 IVANHOE AVE STE 320
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-4518
Country	:	US
Telephone Number	:	303-317-6504
Fax Number	:	800-878-7002

Authorized Official
Title or Position	:	CEO
Name	:	PAUL GRAF
Credential	:
Telephone Number	:	646-523-5264

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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