NPIMap

Organization Active NPI

Mendocino County Youth Project

  • Community/Behavioral Health Agency
  • Ukiah, CA
National Provider Identifier
1225182470
Registry record updated Mar 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MENDOCINO COUNTY YOUTH PROJECT
Practice address
776 S State St
#107
Ukiah, CA 95482
Phone
(707) 463-4915
Fax
(707) 463-4917
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2014

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

Authorized official

Name
Serena Jones, LCSW
Title
Director of Clinical Program
Phone
(707) 463-4915

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

776 S State St
#107
Ukiah, CA 95482

Mailing address

776 South State St.
#107
Ukiah, CA 95482
Phone (707) 463-4915

Other identifiers 1

IdentifierTypeStateIssuer
2375OtherCAMEDI-CAL MENDOCINO CO

Other names 1

  • Mendocino Family & Youth Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Mendocino County Youth Project3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

776 S State St
Ste 107
Ukiah, CA 95482
Phone (707) 463-4915

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1225182470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "776 SOUTH STATE ST.",
            "address_2": "#107",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "95482",
            "telephone_number": "707-463-4915",
            "fax_number": "707-463-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "776 S STATE ST",
            "address_2": "#107",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "95482",
            "telephone_number": "707-463-4915",
            "fax_number": "707-463-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO COUNTY YOUTH PROJECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "SERENA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL PROGRAM",
        "authorized_official_telephone_number": "707-463-4915",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL MENDOCINO CO",
            "identifier": "2375",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mendocino Family & Youth Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.