Basic Information
| Provider Information | |||||||||
| NPI: | 1356499420 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHEHALEM YOUTH & FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 VILLA RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971321851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035384874 | ||||||||
| FaxNumber: | 5035381271 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 VILLA RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971321851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035384874 | ||||||||
| FaxNumber: | 5035381271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CATHERS-SEYMOUR | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5035384874 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2193 | OR | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TF0000X | 2193 | OR | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Family | 363LP0808X | 201507040NP-PP | OR | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 103G00000X | 2193 | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 230442 | 01 | OR | DMAP PROVIDER | OTHER |