Provider Demographics
NPI:1750400065
Name:COMPREHENSIVE YOUTH SERVICES INC
Entity type:Organization
Organization Name:COMPREHENSIVE YOUTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-463-7079
Mailing Address - Street 1:2 CROCKER BOULEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2558
Mailing Address - Country:US
Mailing Address - Phone:586-463-7079
Mailing Address - Fax:586-468-4505
Practice Address - Street 1:2 CROCKER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-463-7079
Practice Address - Fax:586-468-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI500017251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
125582OtherVALUE OPTIONS
MI20476OtherBCBSM
125582OtherVALUE OPTIONS