Provider Demographics
NPI:1932496775
Name:YOUNG, BRADLEY RONALD (MA, MDIV, LPC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:RONALD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18650 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8491
Mailing Address - Country:US
Mailing Address - Phone:503-928-4777
Mailing Address - Fax:503-928-4779
Practice Address - Street 1:18650 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8491
Practice Address - Country:US
Practice Address - Phone:503-928-4777
Practice Address - Fax:503-928-4779
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional