Provider Demographics
NPI:1861068322
Name:YOUNG, HEATHER L (CADC-R/CRM/PSS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CADC-R/CRM/PSS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:ZERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-R/CRM/PSS
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105318175T00000X
ORT-21-749101YA0400X
OR21-CRM-438101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500802087Medicaid