NPIMap

Organization Active NPI

Huckleberry Youth Program

  • Community/Behavioral Health Agency
  • San Rafael, CA
National Provider Identifier
1538429501
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HUCKLEBERRY YOUTH PROGRAM
Practice address
361 3Rd St Ste G
San Rafael, CA 94901-3580
Phone
(415) 258-4944
Fax
(415) 258-4943
NPI assigned
May 23, 2012
Last updated
Sep 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Authorized official

Name
Dr. Douglas Styles, PSYD
Title
Executive Director
Phone
(415) 668-2622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

361 3Rd St Ste G
San Rafael, CA 94901-3580

Mailing address

361 3Rd St Ste G
San Rafael, CA 94901-3580
Phone (415) 258-4944

National Provider Directory

National Provider Directory
Tax ID family
Huckleberry Youth Programs Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1538429501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 3RD ST STE G",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013580",
            "telephone_number": "415-258-4944",
            "fax_number": "415-258-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 3RD ST STE G",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013580",
            "telephone_number": "415-258-4944",
            "fax_number": "415-258-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUCKLEBERRY YOUTH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-23",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "STYLES",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-668-2622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.