# YOUTH VILLAGES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992243992
- **Authorized official:** DAINA MICHELLE TAGUE LMSW, QHMP (ER DIVERSION SPECIALIST)
- **Authorized official phone:** (541) 513-4998

## Contact information

- **Practice address:** 2507 CHRISTIE DR, LAKE OSWEGO, OR 97034
- **Practice address phone:** (503) 635-3416
- **Mailing address:** 12945 SW HAWKS BEARD ST, TIGARD, OR 97223-1956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | M6979 | OR | Yes |

## Other

- **Enumeration date:** 02/09/2017
- **Last updated:** 02/09/2017