Provider Demographics
NPI:1225182470
Name:MENDOCINO COUNTY YOUTH PROJECT
Entity Type:Organization
Organization Name:MENDOCINO COUNTY YOUTH PROJECT
Other - Org Name:MENDOCINO FAMILY & YOUTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL PROGRAM
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-463-4915
Mailing Address - Street 1:776 SOUTH STATE ST.
Mailing Address - Street 2:#107
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:707-463-4917
Practice Address - Street 1:776 S STATE ST
Practice Address - Street 2:#107
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-463-4915
Practice Address - Fax:707-463-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2375OtherMEDI-CAL MENDOCINO CO