NPIMap

Organization Active NPI

Mendocino County Youth Project

  • Community/Behavioral Health Agency
  • Ukiah, CA
National Provider Identifier
1992233159
Registry record updated Jun 16, 2017
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
376 E Gobbi St Ste B
Ukiah, CA 95482-5511
Phone
(707) 463-4915
NPI assigned
May 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2017

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

Authorized official

Name
Mimine Ambrois, LCSW
Title
Director of Clinical Program
Phone
(707) 463-4915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

376 E Gobbi St Ste B
Ukiah, CA 95482-5511

Mailing address

776 S State St Ste 107
Ukiah, CA 95482-5858
Phone (707) 463-4915

Other identifiers 1

IdentifierTypeStateIssuer
94-2882841MedicaidCA

Other names 1

  • MCYP Behavioral Health Services - Medication Support 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.

NPI Registry JSON

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497571200000",
    "number": "1992233159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "776 S STATE ST STE 107",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825858",
            "telephone_number": "707-463-4915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 E GOBBI ST STE B",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825511",
            "telephone_number": "707-463-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO COUNTY YOUTH PROJECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-06-16",
        "status": "A",
        "authorized_official_last_name": "AMBROIS",
        "authorized_official_first_name": "MIMINE",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL PROGRAM",
        "authorized_official_telephone_number": "707-463-4915",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94-2882841",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCYP Behavioral Health Services - Medication Support",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MCYP Behavioral Health Services - Medication Support",
            "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 Jun 16, 2017; 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.