Provider Demographics
NPI:1609696004
Name:YOUTH CONSULTATION SERVICE, INC
Entity type:Organization
Organization Name:YOUTH CONSULTATION SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-482-8411
Mailing Address - Street 1:284 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4003
Mailing Address - Country:US
Mailing Address - Phone:973-482-8411
Mailing Address - Fax:973-482-5918
Practice Address - Street 1:147 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3659
Practice Address - Country:US
Practice Address - Phone:973-482-8411
Practice Address - Fax:973-482-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities