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General NPI Number Information
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NPI Number | 1962730614
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Entity Type | Organization
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Legal Business Name | CHALLENGER MEMORIAL YOUTH CENTER
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 5300 W AVENUE I
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City | LANCASTER
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State | CA
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Zip | 93536-8312
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Country | US
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Telephone | 661-940-4052
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Fax | 661-940-5049
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Provider Business Mailing Address
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Address Line | 5300 W AVENUE I
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City | LANCASTER
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State | CA
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Zip | 93536-8312
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Country | US
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Telephone | 661-940-4052
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Fax | 661-940-5049
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Authorized Official
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Title or Position | MHCII
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Name | MS. LISSETTE DE LEON
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Credential | MFT
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Telephone | 661-940-4052
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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 | MFT 44041
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License Number State | CA
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