| Family And Youth Intervention Services | |
|
5037 S 24th St Ste 2 Phoenix AZ 85040-2604 | |
| (602) 282-8836 | |
| Not Available |
| Full Name | Family And Youth Intervention Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5037 S 24th St Ste 2, Phoenix, Arizona |
| Authorized Official Name and Position | Michael Russell Baines (DIR) |
| Authorized Official Contact | 9188524695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family And Youth Intervention Services Po Box 842 Oologah OK 74053-0842 Ph: (188) 524-6959 | Family And Youth Intervention Services 5037 S 24th St Ste 2 Phoenix AZ 85040-2604 Ph: (602) 282-8836 |
| NPI Number | 1609188853 |
|---|---|
| Provider Enumeration Date | 07/04/2010 |
| Last Update Date | 07/07/2020 |
| Certification Date | 07/07/2020 |
| Medicare PECOS PAC ID | 7810211885 |
|---|---|
| Medicare Enrollment ID | O20150122000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609188853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Oklahoma) | Primary |
| Provider Name | Charles Lee Vaughan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114139896 PECOS PAC ID: 9335203975 Enrollment ID: I20090127000456 |
| Provider Name | Kathy Ridgway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508994138 PECOS PAC ID: 4284959321 Enrollment ID: I20150211001725 |
| Provider Name | Jennifer Kauffman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588707202 PECOS PAC ID: 1850611997 Enrollment ID: I20150513001589 |
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