Provider Demographics
NPI:1770975013
Name:YOUTHERAPY PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:YOUTHERAPY PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-392-2233
Mailing Address - Street 1:2187 FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2943
Mailing Address - Country:US
Mailing Address - Phone:909-392-2233
Mailing Address - Fax:909-392-2288
Practice Address - Street 1:2187 FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2943
Practice Address - Country:US
Practice Address - Phone:909-392-2233
Practice Address - Fax:909-392-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health