Provider Demographics
NPI:1629429436
Name:WESTERN YOUTH SERVICES
Entity Type:Organization
Organization Name:WESTERN YOUTH SERVICES
Other - Org Name:CYS WESTERN YOUTH SERVICES - CENTRAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGH BELHUMEUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-855-1556
Mailing Address - Street 1:18350 MOUNT LANGLEY ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6900
Mailing Address - Country:US
Mailing Address - Phone:949-855-1556
Mailing Address - Fax:949-951-2871
Practice Address - Street 1:18350 MOUNT LANGLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6900
Practice Address - Country:US
Practice Address - Phone:949-855-1556
Practice Address - Fax:949-951-2871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN YOUTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health