Healthcare Provider Details

I. General information

NPI: 1265636815
Provider Name (Legal Business Name): VASHON YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20110 VASHON HWY SW
VASHON WA
98070
US

IV. Provider business mailing address

PO BOX 237
VASHON WA
98070
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-5511
  • Fax: 206-632-5513
Mailing address:
  • Phone: 206-463-5511
  • Fax: 206-463-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number159
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number17 1460 00
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number159
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number159
License Number StateWA

VIII. Authorized Official

Name: MRS. MARIANNE R ROSE
Title or Position: CD CLINICAL SUPERVISOR
Credential: MA CDP
Phone: 206-463-5511