Healthcare Provider Details

I. General information

NPI: 1518973445
Provider Name (Legal Business Name): DAYBREAK YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MULLAN RD SUITE 120
SPOKANE VALLEY WA
99206
US

IV. Provider business mailing address

960 E 3RD AVE
SPOKANE WA
99202-2241
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-1688
  • Fax: 509-444-7038
Mailing address:
  • Phone: 509-444-7033
  • Fax: 509-927-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32011600
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number32011600
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32011600
License Number StateWA

VIII. Authorized Official

Name: MR. THOMAS RUSSELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 509-444-7033