Provider Demographics
NPI:1144531138
Name:YOUNG, REBECCA LEE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:LEE
Other - Last Name:LOCKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12647 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7035
Mailing Address - Country:US
Mailing Address - Phone:503-928-4777
Mailing Address - Fax:503-928-4779
Practice Address - Street 1:12647 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7035
Practice Address - Country:US
Practice Address - Phone:503-928-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC2227101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor