Healthcare Provider Details

I. General information

NPI: 1235070392
Provider Name (Legal Business Name): BRIANNA NICOLE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW COLUMBIA ST STE 103
BEND OR
97702-1175
US

IV. Provider business mailing address

300 SW COLUMBIA ST STE 103
BEND OR
97702-1175
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-0978
  • Fax: 541-728-0979
Mailing address:
  • Phone: 541-728-0978
  • Fax: 541-728-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: