MEDICARE: JAMAICA YOUNG TARTER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1306122916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAICA YOUNG TARTER LMT

Provider Business Mailing Address
First Line	:	365 WARNER MILNE RD
Second Line	:	SUITE 105
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4073
Country	:	US
Telephone Number	:	503-557-9266
Fax Number	:	503-557-9220

Provider Business Practice Location Address
First Line	:	365 WARNER MILNE RD
Second Line	:	SUITE 105
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4073
Country	:	US
Telephone Number	:	503-557-9266
Fax Number	:	503-557-9220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	04/25/2024

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