Provider Demographics
NPI:1265682504
Name:FRED FINCH YOUTH CENTER
Entity Type:Organization
Organization Name:FRED FINCH YOUTH CENTER
Other - Org Name:FRED FINCH YOUTH CENTER-WRAP #2
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-482-2244
Mailing Address - Street 1:910 W SAN MARCOS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1117
Mailing Address - Country:US
Mailing Address - Phone:619-281-3706
Mailing Address - Fax:760-796-4397
Practice Address - Street 1:910 W SAN MARCOS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1117
Practice Address - Country:US
Practice Address - Phone:619-281-3706
Practice Address - Fax:760-796-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty