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General NPI Number Information
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NPI Number | 1407768278
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Entity Type | Organization
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Legal Business Name | BOYS & GIRLS CLUB OF MANTECA
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 545 W ALAMEDA ST
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City | MANTECA
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State | CA
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Zip | 95336-3634
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Country | US
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Telephone | 209-239-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 545 W ALAMEDA ST
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City | MANTECA
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State | CA
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Zip | 95336-3634
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Country | US
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Telephone | 209-239-5437
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. SARA YOUNG
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Credential |
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Telephone | 209-239-5437
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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 |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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