1932496775 NPI number — MR. BRADLEY RONALD YOUNG M.A., M.DIV., L.P.C.

Table of content: MR. BRADLEY RONALD YOUNG M.A., M.DIV., L.P.C. (NPI 1932496775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932496775 NPI number — MR. BRADLEY RONALD YOUNG M.A., M.DIV., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
BRADLEY
Provider Middle Name:
RONALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., M.DIV., L.P.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932496775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18650 SW BOONES FERRY RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
TUALATIN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97062-8491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-928-4777
Provider Business Mailing Address Fax Number:
503-928-4779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18650 SW BOONES FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
TUALATIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97062-8491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-928-4777
Provider Business Practice Location Address Fax Number:
503-928-4779
Provider Enumeration Date:
06/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C2228 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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