NPIMap

Organization Active NPI

Daybreak Youth Services

  • Mental Health Counselor
  • Vancouver, WA
National Provider Identifier
1003199712
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
06155400 Issued in WA
Legal business name
DAYBREAK YOUTH SERVICES
Practice address
11818 SE Mill Plain Blvd
Suite 307
Vancouver, WA 98684
Phone
(360) 750-9635
Fax
(360) 334-9541
NPI assigned
Sep 20, 2011
Organization subpart
Yes
Parent organization
DAYBREAK YOUTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas Russell
Title
Ceo
Phone
(509) 444-7033

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 06155400 WA
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 06155400 WA Primary
Case Management Agency 251B00000X 06155400 WA

Addresses

Primary practice location

11818 SE Mill Plain Blvd
Suite 307
Vancouver, WA 98684

Mailing address

960 E 3Rd Ave
Spokane, WA 99202-2241
Phone (509) 444-7033

Other identifiers 2

IdentifierTypeStateIssuer
2015313MedicaidWA
155400OtherWAWA STATE DBHR

Other names 1

  • Daybreak Vancouver Outpatient Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Daybreak Youth Services4 organizations share this tax ID, including this one
Part of
Daybreak Youth Services

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11818 SE Mill Plain Blvd
Ste 307
Vancouver, WA 98684
Phone (360) 750-9635

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1003199712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 E 3RD AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022241",
            "telephone_number": "509-444-7033",
            "fax_number": "509-927-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11818 SE MILL PLAIN BLVD",
            "address_2": "SUITE 307",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98684",
            "telephone_number": "360-750-9635",
            "fax_number": "360-334-9541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYBREAK YOUTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAYBREAK YOUTH SERVICES",
        "enumeration_date": "2011-09-20",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-444-7033",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "06155400",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "06155400",
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WA",
            "license": "06155400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015313",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE DBHR",
            "identifier": "155400",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Daybreak Vancouver Outpatient",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Daybreak Vancouver Outpatient",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.