1780037523 NPI number — PRO YOUTH CENTERS

Table of content: DR. WILLIAM D. JENKINS PH.D., M.F.T. (NPI 1841488723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780037523 NPI number — PRO YOUTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO YOUTH CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780037523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28816 CONEJO VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGOURA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91301-3367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-889-0091
Provider Business Mailing Address Fax Number:
818-532-7919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1783 TEMPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-3367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-388-1035
Provider Business Practice Location Address Fax Number:
805-388-1062
Provider Enumeration Date:
07/17/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCREE
Authorized Official First Name:
MIKI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/FOUNDER
Authorized Official Telephone Number:
818-469-6029

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  565801695 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)