Healthcare Provider Details

I. General information

NPI: 1164925368
Provider Name (Legal Business Name): FRED FINCH YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 PALM ST
LEMON GROVE CA
91945-3026
US

IV. Provider business mailing address

3800 COOLIDGE AVE
OAKLAND CA
94602-3311
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1090
  • Fax: 619-797-1091
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-488-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS N. ALEXANDER
Title or Position: PRESIDENT AND CEO
Credential: LCSW
Phone: 510-482-2244