Healthcare Provider Details

I. General information

NPI: 1295114189
Provider Name (Legal Business Name): JEFFREY GENE YORK MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 05/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 SW TUALATIN VALLEY HWY
BEAVERTON OR
97003-5143
US

IV. Provider business mailing address

5820 SE MILWAUKIE AVE
PORTLAND OR
97202-5256
US

V. Phone/Fax

Practice location:
  • Phone: 503-649-5651
  • Fax:
Mailing address:
  • Phone: 503-568-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: