Healthcare Provider Details

I. General information

NPI: 1619378403
Provider Name (Legal Business Name): WESTERN YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E LINCOLN AVE APT 116
ANAHEIM CA
92806-4045
US

IV. Provider business mailing address

2900 E. LINCOLN AVE APT 116
ANAHEIM CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 714-883-1333
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number60581
License Number StateCA

VIII. Authorized Official

Name: MISS JESSICA G SALDIVAR
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 714-883-1333