Provider Demographics
NPI:1205559747
Name:YOUTH CONSULTATION SERVICE, INC
Entity type:Organization
Organization Name:YOUTH CONSULTATION SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-678-1312
Mailing Address - Street 1:284 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4003
Mailing Address - Country:US
Mailing Address - Phone:973-482-8411
Mailing Address - Fax:973-482-2907
Practice Address - Street 1:284 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4003
Practice Address - Country:US
Practice Address - Phone:973-482-8411
Practice Address - Fax:973-482-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility