Organization
YOUTH INTERACTIVE PREVENTION SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRISHA MARIE BORRESEN (CEO)
(208) 324-6885
Entity
Organization
Contact information
Practice address
152 E MAIN ST, JEROME, ID 83338-2333
(208) 324-6885
Mailing address
152 E MAIN ST, JEROME, ID 83338-2333
(208) 324-6885
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/13/2009
Last updated
11/13/2009
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