Healthcare Provider Details

I. General information

NPI: 1831972140
Provider Name (Legal Business Name): WESTERN YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 S HARBOR BLVD FL 2
SANTA ANA CA
92704-6951
US

IV. Provider business mailing address

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

V. Phone/Fax

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

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: COO
Credential: LCSW
Phone: 949-855-1556