Provider Demographics
NPI:1831972140
Name:WESTERN YOUTH SERVICES
Entity type:Organization
Organization Name:WESTERN YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-855-1556
Mailing Address - Street 1:23461 S POINTE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3631 S HARBOR BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6951
Practice Address - Country:US
Practice Address - Phone:949-855-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN YOUTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health