Provider Demographics
NPI:1821240250
Name:YOUNG HOUSE FAMILY SERVICES
Entity Type:Organization
Organization Name:YOUNG HOUSE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE COUNSELOR PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-752-8095
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-0845
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:319-752-6933
Practice Address - Street 1:4717 SULLIVAN SLOUGH RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9013
Practice Address - Country:US
Practice Address - Phone:319-752-8095
Practice Address - Fax:319-758-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health