Provider Demographics
NPI:1306112198
Name:SANTA MARIA VALLEY YOUTH & FAMILY SERVICES CENTER
Entity type:Organization
Organization Name:SANTA MARIA VALLEY YOUTH & FAMILY SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-260-0718
Mailing Address - Street 1:105 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4319
Mailing Address - Country:US
Mailing Address - Phone:805-928-1707
Mailing Address - Fax:
Practice Address - Street 1:105 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4319
Practice Address - Country:US
Practice Address - Phone:805-928-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69781252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency