Healthcare Provider Details

I. General information

NPI: 1124113527
Provider Name (Legal Business Name): YOUTH CONTACT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 SE BASELINE ST
HILLSBORO OR
97123-4103
US

IV. Provider business mailing address

447 SE BASELINE ST
HILLSBORO OR
97123-4103
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-4222
  • Fax: 503-640-0334
Mailing address:
  • Phone: 503-640-4222
  • Fax: 503-640-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name: JUDY R HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW
Phone: 503-640-4222