Provider Demographics
NPI:1265636815
Name:VASHON YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:VASHON YOUTH AND FAMILY SERVICES
Other - Org Name:VYFS
Other - Org Type:Other Name
Authorized Official - Title/Position:CD CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CDP
Authorized Official - Phone:206-463-5511
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070
Mailing Address - Country:US
Mailing Address - Phone:206-463-5511
Mailing Address - Fax:206-463-5513
Practice Address - Street 1:20110 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-463-5511
Practice Address - Fax:206-632-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA159251S00000X, 261QM0850X, 261QM0855X
WA17 1460 00261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601091281OtherUBI STATE LICENSE
WARU#651Medicaid