Provider Demographics
NPI:1326453051
Name:SOUTHEAST YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:SOUTHEAST YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CMHS, EMMHS
Authorized Official - Phone:206-721-5542
Mailing Address - Street 1:3722 S HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1920
Mailing Address - Country:US
Mailing Address - Phone:206-721-5542
Mailing Address - Fax:206-721-5917
Practice Address - Street 1:3722 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1920
Practice Address - Country:US
Practice Address - Phone:206-721-5542
Practice Address - Fax:206-721-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA173251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health