Provider Demographics
NPI:1770845497
Name:YOUTHS' HOPE LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:YOUTHS' HOPE LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:YOUTH HOPE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:BESTMAN
Authorized Official - Last Name:IBEABUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:909-567-2808
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:PATTOM
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0264
Mailing Address - Country:US
Mailing Address - Phone:909-567-2808
Mailing Address - Fax:909-567-2808
Practice Address - Street 1:255 N. D STREET,
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401
Practice Address - Country:US
Practice Address - Phone:909-567-2808
Practice Address - Fax:909-567-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCS 183571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty