Provider Demographics
NPI:1356757108
Name:YOUTH VILLAGES
Entity type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILINGUAL INTERCEPT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BERENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA CABELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,QMHP
Authorized Official - Phone:503-974-5816
Mailing Address - Street 1:15544 S CLACKAMAS RIVER DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9490
Mailing Address - Country:US
Mailing Address - Phone:503-974-5816
Mailing Address - Fax:503-607-0211
Practice Address - Street 1:15544 S CLACKAMAS RIVER DR
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9490
Practice Address - Country:US
Practice Address - Phone:503-974-5816
Practice Address - Fax:503-607-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty