Provider Demographics
NPI:1881363968
Name:CYS WAYMAKERS TAY CRP
Entity type:Organization
Organization Name:CYS WAYMAKERS TAY CRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO-YOUTH DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:HETHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOMBARDO-BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-250-0488
Mailing Address - Street 1:440 EXCHANGE STE 250
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1390
Mailing Address - Country:US
Mailing Address - Phone:949-250-0488
Mailing Address - Fax:714-540-1908
Practice Address - Street 1:17332 AMAGANSET WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2508
Practice Address - Country:US
Practice Address - Phone:714-845-7690
Practice Address - Fax:714-415-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health