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General NPI Number Information
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NPI Number | 1750441721
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Entity Type | Organization
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Legal Business Name | HUCKLEBERRY YOUTH PROGRAMS, INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 555 COLE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-2800
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Country | US
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Telephone | 415-621-2929
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Fax | 415-621-4758
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Provider Business Mailing Address
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Address Line | 555 COLE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-2800
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Country | US
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Telephone | 415-621-2929
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Fax | 415-621-4758
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DOUGLAS STYLES
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Credential | PSYD
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Telephone | 415-668-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 00623
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License Number State | CA
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