Provider Demographics
NPI:1932399359
Name:KENT YOUTH AND FAMILY SERVICES
Entity type:Organization
Organization Name:KENT YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEINISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MC,NCC
Authorized Official - Phone:253-859-0300
Mailing Address - Street 1:232 2ND AVE S
Mailing Address - Street 2:STE 201
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5862
Mailing Address - Country:US
Mailing Address - Phone:253-859-0300
Mailing Address - Fax:253-859-0745
Practice Address - Street 1:232 2ND AVE S
Practice Address - Street 2:STE 201
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5862
Practice Address - Country:US
Practice Address - Phone:253-859-0300
Practice Address - Fax:253-859-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991686Medicaid