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General NPI Number Information
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NPI Number | 1326546102
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Entity Type | Organization
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Legal Business Name | YOUTH ALLIANCE
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 310 4TH ST STE 101
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City | HOLLISTER
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State | CA
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Zip | 95023-3858
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Country | US
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Telephone | 831-636-2853
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Fax | 831-636-2850
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Provider Business Mailing Address
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Address Line | PO BOX 1291
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City | HOLLISTER
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State | CA
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Zip | 95024-1291
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Country | US
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Telephone | 831-636-2853
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Fax | 831-636-2850
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DIANE ORTIZ
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Credential | MSW
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Telephone | 831-636-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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