Healthcare Provider Details

I. General information

NPI: 1679605489
Provider Name (Legal Business Name): WESTERN YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/25/2025
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. SANTA ANA BLVD STE. 801
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

200 W. SANTA ANA BLVD STE. 801
SANTA ANA CA
92701-4134
US

V. Phone/Fax

Practice location:
  • Phone: 714-704-5900
  • Fax: 714-978-3419
Mailing address:
  • Phone: 714-704-5900
  • Fax: 714-978-3419

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: KATHERINE NOVEMBER
Title or Position: CHIEF OPERATING OFFICER
Credential: LCSW
Phone: 949-330-1676