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NPI Code Detail

MEDICARE: NATHANIEL AEDEN SUNDHOLM-YOUNG

MEDICARE: NATHANIEL AEDEN SUNDHOLM-YOUNG
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528904323
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL AEDEN SUNDHOLM-YOUNG
Provider Business Mailing Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3740
Fax Number :
Provider Business Practice Location Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2026
Last Update Date : 04/25/2026

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Directions to “ NATHANIEL AEDEN SUNDHOLM-YOUNG ” Practice Location

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