Provider Demographics
NPI:1881735652
Name:NORTHSTORE YOUTH & FAMILY SVCS
Entity type:Organization
Organization Name:NORTHSTORE YOUTH & FAMILY SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:425-485-6541
Mailing Address - Street 1:10309 NORTHEAST 185TH STREET
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3437
Mailing Address - Country:US
Mailing Address - Phone:425-485-6541
Mailing Address - Fax:425-485-4154
Practice Address - Street 1:10309 NORTHEAST 185TH STREET
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3437
Practice Address - Country:US
Practice Address - Phone:425-485-6541
Practice Address - Fax:425-485-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)