Basic Information
| Provider Information | |||||||||
| NPI: | 1457480220 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUOIA YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514-516 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | 5595944308 | ||||||||
| Practice Location | |||||||||
| Address1: | 514-516 N KAWEAH AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595944969 | ||||||||
| FaxNumber: | 5595944308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | ORTIZ | ||||||||
| AuthorizedOfficialFirstName: | HIPOLITO | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5595944969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TURNING POINT OF CENTRAL CALIFORNIA INC. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.