Healthcare Provider Details

I. General information

NPI: 1700236296
Provider Name (Legal Business Name): YOUTH EDUCATION AND SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S 165TH LN
GOODYEAR AZ
85338-6013
US

IV. Provider business mailing address

625 W SOUTHERN AVE # E-131
MESA AZ
85210-5030
US

V. Phone/Fax

Practice location:
  • Phone: 480-688-8455
  • Fax:
Mailing address:
  • Phone: 480-688-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN M. MCGLYNN
Title or Position: CEO/PRESIDENT
Credential: PHD
Phone: 480-688-8455