Healthcare Provider Details

I. General information

NPI: 1720431661
Provider Name (Legal Business Name): MOLLY YOUNG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SE 196TH AVE STE 102
CAMAS WA
98607-8862
US

IV. Provider business mailing address

1901 MAIN ST
WASHOUGAL WA
98671-4116
US

V. Phone/Fax

Practice location:
  • Phone: 360-583-4900
  • Fax: 877-289-1130
Mailing address:
  • Phone: 360-583-4900
  • Fax: 877-289-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61521422
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3638
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: