Provider Demographics
NPI:1710294863
Name:FRIENDS OF YOUTH
Entity Type:Organization
Organization Name:FRIENDS OF YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR SA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CDP
Authorized Official - Phone:425-392-6367
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:414 FRONT ST N
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0001
Mailing Address - Country:US
Mailing Address - Phone:425-392-6367
Mailing Address - Fax:425-391-4971
Practice Address - Street 1:414 FRONT ST N.
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98045-0001
Practice Address - Country:US
Practice Address - Phone:425-392-6367
Practice Address - Fax:425-391-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60166490252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency