Healthcare Provider Details

I. General information

NPI: 1356499420
Provider Name (Legal Business Name): CHEHALEM YOUTH & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 VILLA RD STE 3
NEWBERG OR
97132-1851
US

IV. Provider business mailing address

504 VILLA RD STE 3
NEWBERG OR
97132-1851
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-4874
  • Fax: 503-538-1271
Mailing address:
  • Phone: 503-538-4874
  • Fax: 503-538-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2193
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number2193
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201507040NP-PP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2193
License Number StateOR

VIII. Authorized Official

Name: DEBORAH CATHERS-SEYMOUR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-538-4874