Basic Information
| Provider Information | |||||||||
| NPI: | 1215272562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, QMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 SW OAK ST | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972041817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039885464 | ||||||||
| FaxNumber: | 5039885870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 SW 3RD AVE STE 358 | ||||||||
| Address2: | JUSTICE CENTER-COMMUNITY COURT SOCIAL SERVICES | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972042828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039885090 | ||||||||
| FaxNumber: | 5039883877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.