Provider Demographics
NPI:1235355272
Name:SANTA CRUZ COMMUNITY COUNSELING CENTER
Entity Type:Organization
Organization Name:SANTA CRUZ COMMUNITY COUNSELING CENTER
Other - Org Name:YOUTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-469-1700
Mailing Address - Street 1:195 HARVEY WEST BLVD # A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2126
Mailing Address - Country:US
Mailing Address - Phone:831-469-1700
Mailing Address - Fax:831-425-1905
Practice Address - Street 1:255 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4717
Practice Address - Country:US
Practice Address - Phone:831-728-2227
Practice Address - Fax:831-728-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health