Provider Demographics
NPI:1912504929
Name:3RD STREET YOUTH CENTER & CLINIC
Entity type:Organization
Organization Name:3RD STREET YOUTH CENTER & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-877-1707
Mailing Address - Street 1:1728 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2697
Mailing Address - Country:US
Mailing Address - Phone:415-877-1707
Mailing Address - Fax:415-822-1723
Practice Address - Street 1:1728 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2697
Practice Address - Country:US
Practice Address - Phone:415-877-1707
Practice Address - Fax:415-822-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty