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General NPI Number Information
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NPI Number | 1265084685
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Entity Type | Individual
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Provider Name | SARA J YOUNG PSS CRMII QMHA CADCI
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Gender | Female
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 1027 E BURNSIDE ST
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City | PORTLAND
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State | OR
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Zip | 97214-1328
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Country | US
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Telephone | 503-239-8444
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Fax | 503-239-8400
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Provider Business Mailing Address
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Address Line | 194 WONDERLY DR
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City | SAINT HELENS
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State | OR
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Zip | 97051-1632
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Country | US
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Telephone | 971-363-5685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-20-112
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19-QMHA-I-02752
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | THW000003584
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 22-03-10374
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License Number State | OR
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