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General NPI Number Information
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NPI Number | 1801188826
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Entity Type | Organization
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Legal Business Name | TAHOE YOUTH & FAMILY SERVICES
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 1735 LAKE TAHOE BLVD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3718
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Country | US
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Telephone | 530-543-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 FREMONT AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-8136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALISSA NOURSE
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Credential |
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Telephone | 530-541-2445
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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 |
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License Number State |
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