Provider Demographics
NPI:1194942144
Name:RENTON AREA YOUTH AND FAMILY SERVICES
Entity type:Organization
Organization Name:RENTON AREA YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:425-271-5600
Mailing Address - Street 1:1025 S. 3RD ST.
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2765
Mailing Address - Country:US
Mailing Address - Phone:425-271-5600
Mailing Address - Fax:425-227-8926
Practice Address - Street 1:1025 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2765
Practice Address - Country:US
Practice Address - Phone:425-271-5600
Practice Address - Fax:425-227-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991348Medicaid