Organization
YOUTH VILLAGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAINA MICHELLE TAGUE LMSW, QHMP (ER DIVERSION SPECIALIST)
(541) 513-4998
Entity
Organization
Contact information
Practice address
2507 CHRISTIE DR, LAKE OSWEGO, OR 97034
(503) 635-3416
Mailing address
12945 SW HAWKS BEARD ST, TIGARD, OR 97223-1956
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
M6979
OR
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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