MEDICARE: KENT YOUTH AND FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	152	WA
2	251B00000X	Case Management Agency	152	WA

General Provider Information

NPI Number	:	1285837849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT YOUTH AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	232 2ND AVE S
Second Line	:	SUITE 201
City	:	KENT
State	:	WA
Zip	:	98032-5862
Country	:	US
Telephone Number	:	253-859-0300
Fax Number	:	253-859-0745

Provider Business Practice Location Address
First Line	:	232 2ND AVE S
Second Line	:	SUITE 201
City	:	KENT
State	:	WA
Zip	:	98032-5862
Country	:	US
Telephone Number	:	253-859-0300
Fax Number	:	253-859-0745

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. DENNIS L BALLINGER
Credential	:	MA, LMFT
Telephone Number	:	253-859-0300

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/11/2025

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1528243375 — MRS. JENNIFER WAGNER LMHC, SUDPT
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Directions to “KENT YOUTH AND FAMILY SERVICES ” Practice Location

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