Provider Demographics
NPI:1114265915
Name:FRIENDS OF YOUTH
Entity Type:Organization
Organization Name:FRIENDS OF YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE TREATMENT COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GINNETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CDPT
Authorized Official - Phone:425-888-4151
Mailing Address - Street 1:7972 MAPLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065
Mailing Address - Country:US
Mailing Address - Phone:425-888-4151
Mailing Address - Fax:
Practice Address - Street 1:7972 MAPLE AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065
Practice Address - Country:US
Practice Address - Phone:425-888-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005218251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management