Provider Demographics
NPI:1720431661
Name:YOUNG, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SW 6TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1345
Mailing Address - Country:US
Mailing Address - Phone:503-334-3035
Mailing Address - Fax:503-961-9212
Practice Address - Street 1:8915 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6307
Practice Address - Country:US
Practice Address - Phone:503-726-3698
Practice Address - Fax:503-726-3699
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61521422103TC0700X
OR3638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical