Provider Demographics
NPI:1225300320
Name:SANTA FE ADOLESCENT SERVICES
Entity Type:Organization
Organization Name:SANTA FE ADOLESCENT SERVICES
Other - Org Name:SANTA FE YOUTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-492-4673
Mailing Address - Street 1:7524 MOSIER VIEW CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7148
Mailing Address - Country:US
Mailing Address - Phone:817-492-4673
Mailing Address - Fax:817-492-8974
Practice Address - Street 1:7524 MOSIER VIEW CT
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7148
Practice Address - Country:US
Practice Address - Phone:817-492-4673
Practice Address - Fax:817-492-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty