Provider Demographics
NPI:1497158182
Name:YOUTH CRISIS CENTER, INC
Entity Type:Organization
Organization Name:YOUTH CRISIS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSHIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-5718
Mailing Address - Street 1:1656 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4004
Mailing Address - Country:US
Mailing Address - Phone:307-577-5718
Mailing Address - Fax:307-577-5716
Practice Address - Street 1:1656 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4004
Practice Address - Country:US
Practice Address - Phone:307-577-5718
Practice Address - Fax:307-577-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2023-11-02
Deactivation Date:2023-08-17
Deactivation Code:
Reactivation Date:2023-11-02
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1164101YM0800X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty