Community Youth Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

281 Issued in WA

Legal business name

COMMUNITY YOUTH SERVICES

Practice address

711 State Ave NE
Olympia, WA 98506-3984

Phone

(360) 943-0780

Fax

(360) 943-0785

NPI assigned

Oct 17, 2012

Organization subpart

No

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

Authorized official

Name

Derek Ray Harris

Title

Ceo

Phone

(360) 918-0780

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 501983

Legal name

SEA-MAR CHC - COMMUNITY YOUTH SERVICES

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 31, 2014

Last certification

Oct 31, 2014

Ownership / control type

For profit – corporation

Facility address

711 State Avenue NE
Olympia, WA 98506

Locations

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1386997138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985063984",
            "telephone_number": "360-943-0780",
            "fax_number": "360-943-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985063984",
            "telephone_number": "360-943-0780",
            "fax_number": "360-943-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-918-0780"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca A Combs, LMP
• Kelly Lynn Comeau
• Kenneth Douglas Common, O.D.
• Community Chiropractic PS
• Community Health Outreach
• Compassionate Pathways Psychology Services, LLC
• Compassionate Psychiatry, PLLC
• Comstock Physical Therapy
• Kelly Lynn Comstock, M.A.
• Linnea Comstock, PT

• Community/Behavioral Health Agency in Olympia, WA
• Providers in Olympia, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.