Healthcare Provider Details

I. General information

NPI: 1952875528
Provider Name (Legal Business Name): WESTERN YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S HARBOR BLVD
ANAHEIM CA
92805-5157
US

IV. Provider business mailing address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

V. Phone/Fax

Practice location:
  • Phone: 714-450-4118
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-951-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LORRAYNE LEIGH BELHUMER
Title or Position: CEO
Credential: PH.D.
Phone: 949-855-1556