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General NPI Number Information
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NPI Number | 1528164852
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Entity Type | Organization
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Legal Business Name | YOUTH SERVICE BUREAU INC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 PINE ST W
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City | STILLWATER
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State | MN
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Zip | 55082-4994
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Country | US
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Telephone | 651-439-8800
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Fax | 651-439-1040
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Provider Business Mailing Address
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Address Line | 101 W PINE ST
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City | STILLWATER
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State | MN
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Zip | 55082
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Country | US
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Telephone | 651-439-8800
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Fax | 651-439-1040
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | PAUL P WEILER
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Credential | MA
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Telephone | 651-439-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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