Provider Demographics
NPI:1841417409
Name:FRONT ST INC
Entity Type:Organization
Organization Name:FRONT ST INC
Other - Org Name:WILLOWBROOK MENTAL HEALTH SUPPORT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-420-0120
Mailing Address - Street 1:2115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1663
Mailing Address - Country:US
Mailing Address - Phone:831-420-0120
Mailing Address - Fax:831-420-0136
Practice Address - Street 1:155 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9714
Practice Address - Country:US
Practice Address - Phone:831-420-0120
Practice Address - Fax:831-420-0136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT ST INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44AZOtherMEDI-CAL PRV NBR