MEDICARE: YOUTH ENTERPRISE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1568098242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH ENTERPRISE, INC.

Provider Business Mailing Address
First Line	:	231 E ALESSANDRO BLVD # A317
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5084
Country	:	US
Telephone Number	:	310-902-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 E ALESSANDRO BLVD # A317
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5084
Country	:	US
Telephone Number	:	310-902-9266
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALINA WHITMORE
Credential	:	PSY.D., LMFT
Telephone Number	:	310-902-9266

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/07/2023

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Directions to “YOUTH ENTERPRISE, INC. ” Practice Location

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