Healthcare Provider Details

I. General information

NPI: 1598386021
Provider Name (Legal Business Name): TREVOR SHAWN YOUNGQUIST MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 NE VANCOUVER MALL DR STE 207
VANCOUVER WA
98662-6191
US

IV. Provider business mailing address

9407 NE VANCOUVER MALL DR STE 207
VANCOUVER WA
98662-6191
US

V. Phone/Fax

Practice location:
  • Phone: 206-588-6106
  • Fax:
Mailing address:
  • Phone: 206-588-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61254033
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61085665
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: