Healthcare Provider Details

I. General information

NPI: 1629429436
Provider Name (Legal Business Name): WESTERN YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 MOUNT LANGLEY ST SUITE 140
FOUNTAIN VALLEY CA
92708-6900
US

IV. Provider business mailing address

18350 MOUNT LANGLEY ST SUITE 140
FOUNTAIN VALLEY CA
92708-6900
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax: 949-951-2871
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 StateCA

VIII. Authorized Official

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