Organization
NEW AVENUES FOR YOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN SUIB LCSW (EXECUTIVE DIRECTOR)
(503) 517-3921
Entity
Organization
Contact information
Practice address
2595 CHRISTIE DR., LAKE OSWEGO, OR 97034
(503) 517-3973
(503) 517-3199
Mailing address
1220 SW COLUMBIA STREET, PORTLAND, OR 97201
(503) 224-4339
(503) 501-3198
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/26/2019
Last updated
01/13/2020
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