Provider Demographics
NPI:1326546102
Name:YOUTH ALLIANCE
Entity Type:Organization
Organization Name:YOUTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:831-636-2853
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95024-1291
Mailing Address - Country:US
Mailing Address - Phone:831-636-2853
Mailing Address - Fax:831-636-2850
Practice Address - Street 1:310 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3858
Practice Address - Country:US
Practice Address - Phone:831-636-2853
Practice Address - Fax:831-636-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty