Provider Demographics
NPI:1972584548
Name:DUKE-YOUNG, BEVERLEY (MS)
Entity Type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:
Last Name:DUKE-YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 SE KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2037
Mailing Address - Country:US
Mailing Address - Phone:503-230-1895
Mailing Address - Fax:503-233-8905
Practice Address - Street 1:820 NW 21ST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1409
Practice Address - Country:US
Practice Address - Phone:503-890-1620
Practice Address - Fax:503-233-8905
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist