Provider Demographics
NPI:1265084685
Name:YOUNG, SARA J (PSS CRMII QMHA CADCI)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSS CRMII QMHA CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 WONDERLY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1632
Mailing Address - Country:US
Mailing Address - Phone:971-363-5685
Mailing Address - Fax:
Practice Address - Street 1:1027 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1328
Practice Address - Country:US
Practice Address - Phone:503-239-8444
Practice Address - Fax:503-239-8400
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-20-112101YA0400X
OR19-QMHA-I-02752101YM0800X
ORTHW000003584175T00000X
OR22-03-10374101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000003584OtherOREGON HEALTH AUTHORITY
OR22-03-10374OtherMHACBO
OR19-QMHA-I-02752OtherMHACBO
OR21-CRM-II-0020OtherMHACBO