Provider Demographics
NPI: | 1649542499 |
---|---|
Name: | LARAWAY YOUTH & FAMILY SERVICES, INC. |
Entity type: | Organization |
Organization Name: | LARAWAY YOUTH & FAMILY SERVICES, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | HEATH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 802-635-2805 |
Mailing Address - Street 1: | PO BOX 621 |
Mailing Address - Street 2: | 275 VT. RTE. 15 WEST |
Mailing Address - City: | JOHNSON |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05656-0621 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-635-2805 |
Mailing Address - Fax: | 802-635-7273 |
Practice Address - Street 1: | 275 VT ROUTE 15 W |
Practice Address - Street 2: | |
Practice Address - City: | JOHNSON |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05656-9657 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-635-2805 |
Practice Address - Fax: | 802-635-7273 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-08 |
Last Update Date: | 2012-02-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X | ||
VT | 101YA0400X, 101YM0800X, 101YS0200X, 103K00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 104100000X, 106H00000X, 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |