Provider Demographics
NPI:1386267516
Name:CHANCE YOUNG, WILLIAM DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:CHANCE YOUNG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:DAVID CARLSON
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1200 HILYARD ST STE 540
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8122
Mailing Address - Country:US
Mailing Address - Phone:458-205-7103
Mailing Address - Fax:458-205-7089
Practice Address - Street 1:1200 HILYARD ST STE 540
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8122
Practice Address - Country:US
Practice Address - Phone:458-205-7070
Practice Address - Fax:458-205-7089
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL112641041C0700X
OR20-QMHP-R-0237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical