Provider Demographics
NPI:1972986255
Name:YOUNG ARTISTS' CONSERVATORY OF MUSIC
Entity type:Organization
Organization Name:YOUNG ARTISTS' CONSERVATORY OF MUSIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST-BOARD CERTIFIED
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:707-451-7200
Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4605
Mailing Address - Country:US
Mailing Address - Phone:707-451-7200
Mailing Address - Fax:
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4605
Practice Address - Country:US
Practice Address - Phone:707-451-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health