Basic Information
| Provider Information | |||||||||
| NPI: | 1841847092 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10755 APPLE VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923083684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602479840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10755 APPLE VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923083684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602479840 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | MIKALINIS | ||||||||
| AuthorizedOfficialFirstName: | AIMEE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE | ||||||||
| AuthorizedOfficialTelephone: | 7602479840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.