Provider Demographics
NPI:1740844539
Name:NEW AVENUES FOR YOUTH
Entity type:Organization
Organization Name:NEW AVENUES FOR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUIB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-517-3921
Mailing Address - Street 1:1220 SW COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201
Mailing Address - Country:US
Mailing Address - Phone:503-224-4339
Mailing Address - Fax:503-501-3198
Practice Address - Street 1:2595 CHRISTIE DR.
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034
Practice Address - Country:US
Practice Address - Phone:503-517-3973
Practice Address - Fax:503-517-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty