Healthcare Provider Details

I. General information

NPI: 1639429137
Provider Name (Legal Business Name): JANET ELAINE YOUNG NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32300 SE BLUFF RD
GRESHAM OR
97080-8822
US

IV. Provider business mailing address

PO BOX 634
TROUTDALE OR
97060-0634
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-4105
  • Fax:
Mailing address:
  • Phone: 503-663-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: